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Individual

TRACEE TABARES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
100 S MARKET ST, FREDERICK, MD 21701-5527
(301) 600-1506
Mailing address
702 RUSSELL AVE, GAITHERSBURG, MD 20877-2606
(240) 595-7659

Taxonomy

Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
0001271471
VA
363L00000X
Nurse Practitioner
0024180389
VA
363L00000X
Nurse Practitioner
Primary
AC003567
MD

Other

Enumeration date
05/26/2020
Last updated
06/21/2021
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