Provider Demographics
NPI:1174954820
Name:TRACY, ASHLEY (WHNP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 WHETSTONE WAY
Mailing Address - Street 2:APT #206
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5150
Mailing Address - Country:US
Mailing Address - Phone:802-338-2457
Mailing Address - Fax:
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 500
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:667-214-1300
Practice Address - Fax:410-328-2648
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001235806163W00000X
VA0024171089363LW0102X
MDR218833363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD461389ZAN5Medicare PIN