Provider Demographics
NPI:1265580021
Name:STANSBERRY, TRACEY TIBBALS (ACNS-BC, AOCN)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:TIBBALS
Last Name:STANSBERRY
Suffix:
Gender:F
Credentials:ACNS-BC, AOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 WOODLAND PL
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37756-3809
Mailing Address - Country:US
Mailing Address - Phone:931-484-7596
Mailing Address - Fax:931-484-7597
Practice Address - Street 1:49 CLEVELAND ST STE 270
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-2856
Practice Address - Country:US
Practice Address - Phone:931-484-7596
Practice Address - Fax:931-484-7597
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8239364SA2200X
TNRN-133360 APN-8239363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMS0814120OtherDEA NUMBER
TNMS0814120OtherDEA NUMBER