Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | F430104 | NY |
NPI | 1033388111 |
---|---|
Provider Name | Tracy Valerie Victoriano Bertiz |
First Address | New York, NY 10029 |
Second Address | New York, NY 10029-6500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2008 |
Last Update Date | 22/02/2008 |