Individual
MRS. TRACY LYNNE MCTIERNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
530 1ST AVE, SUITE 10 W, NEW YORK, NY 10016-6402
(212) 263-7391
(212) 263-6590
Mailing address
292 HART AVE, STATEN ISLAND, NY 10310-3024
(718) 816-8768
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F381220
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02091867
—
NY
Enumeration date
04/25/2007
Last updated
02/24/2021
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