| Tracey Elizalde Fnp-bc Pmhnp-bc Llc | |
|
812 Toll House Ave Frederick MD 21701-4519 | |
| (240) 439-5928 | |
| Not Available |
| Full Name | Tracey Elizalde Fnp-bc Pmhnp-bc Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 812 Toll House Ave, Frederick, Maryland |
| Authorized Official Name and Position | Tracey Elizalde (OWNER) |
| Authorized Official Contact | 2404395928 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tracey Elizalde Fnp-bc Pmhnp-bc Llc Po Box 3072 Frederick MD 21705-3072 Ph: () - | Tracey Elizalde Fnp-bc Pmhnp-bc Llc 812 Toll House Ave Frederick MD 21701-4519 Ph: (240) 439-5928 |
| NPI Number | 1720828320 |
|---|---|
| Provider Enumeration Date | 05/30/2024 |
| Last Update Date | 05/30/2024 |
| Certification Date | 05/30/2024 |
| Medicare PECOS PAC ID | 0244777662 |
|---|---|
| Medicare Enrollment ID | O20240802003269 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720828320 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Maria Teresa Elizalde |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538120373 PECOS PAC ID: 5698732378 Enrollment ID: I20041214000829 |
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