Provider Demographics
NPI:1447672308
Name:ANTES, TRACI ELIZABETH (MSN, RN, CPN, CPNPAC)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:ELIZABETH
Last Name:ANTES
Suffix:
Gender:F
Credentials:MSN, RN, CPN, CPNPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 NEW ORLEANS ST
Mailing Address - Street 2:SUITE 6302
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-4904
Mailing Address - Country:US
Mailing Address - Phone:404-432-7273
Mailing Address - Fax:
Practice Address - Street 1:1800 NEW ORLEANS ST
Practice Address - Street 2:SUITE 6302
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-4904
Practice Address - Country:US
Practice Address - Phone:404-432-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR208920363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care