Individual
JILLIAN TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
750 E ADAMS ST RM 3605, SYRACUSE, NY 13210-2306
(315) 464-8035
Mailing address
99 CARPENTER AVE, GROTON, NY 13073-1368
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
347781
NY
Other
Enumeration date
12/07/2021
Last updated
12/07/2021
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