Individual
TRACY MICHELLE NANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 713-9800
Mailing address
PO BOX 602658, CHARLOTTE, NC 28260-2658
(336) 716-2011
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5006732
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558785741
TRICARE
NC
01
—
1558785741
VIRGINIA MEDICAID
VA
05
—
1558785741
—
NC
01
—
185FL
BCBS OF NC
NC
01
—
276984
MECOST
NC
01
—
4108626
UHC
NC
Enumeration date
02/10/2014
Last updated
12/22/2015
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