Provider Demographics
NPI:1982377123
Name:ROSS, TRACY MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:MARIE
Last Name:ROSS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 NORTH HWY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1093
Mailing Address - Country:US
Mailing Address - Phone:507-847-2420
Mailing Address - Fax:507-847-3728
Practice Address - Street 1:1430 NORTH HWY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1093
Practice Address - Country:US
Practice Address - Phone:507-847-2420
Practice Address - Fax:507-847-3728
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-25
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA161952363LF0000X
MN8221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily