1922241538 NPI number — TRACEY ANN VITORI ACNP-BC

Table of content: TRACEY ANN VITORI ACNP-BC (NPI 1922241538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922241538 NPI number — TRACEY ANN VITORI ACNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VITORI
Provider First Name:
TRACEY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ACNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922241538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4030 SMITH RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45209-1974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-245-3663
Provider Business Mailing Address Fax Number:
513-475-7259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2368 VICTORY PKWY STE 501
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45206-2850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-298-8271
Provider Business Practice Location Address Fax Number:
513-872-7385
Provider Enumeration Date:
04/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  APRN.CNP.10633 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100126900 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3091318 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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