Individual
MRS. TRACEY LYNN MESSINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
112 CEDAR AVE, PATCHOGUE, NY 11772-3538
(631) 252-2047
Mailing address
112 CEDAR AVE, PATCHOGUE, NY 11772-3538
(631) 252-2047
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F38330501
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
661462-01
SUNY EDUCATION DEPARTMENT OFFICE OF PROFESSIONS
NY
Enumeration date
03/01/2022
Last updated
03/01/2022
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