| Doctor Name: | TRACY L BLACK |
| NPI Number: | 1538460407 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 003553 |
| Business Practice Address: | 40 Goodwin St New Britain, CT - 060512814 |
| Business Phone Number: | 8608268845 |
| Business Fax Number: | 8608268846 |
| Mailing Address: | 635 Main St, Attn: Credentialing Dept MIDDLETOWN |
| State: | CT |
| Postal Code: | 064572718 |
| Phone Number: | 8603476971 |
| Fax Number: | 8606386601 |
| NPI Enumeration Date: | 11/09/2010 |
| NPI Last Update Date: | 11/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 003553 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |