Tracy Bova

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

338872 Issued in NY

Practice address

13407 New York 12
Boonville, NY 13309

Phone

(315) 942-3500

NPI assigned

Aug 14, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404691200000",
    "number": "1104058791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 TILDEN AVE",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135012007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13407 NEW YORK 12",
            "city": "BOONVILLE",
            "state": "NY",
            "postal_code": "13309",
            "telephone_number": "315-942-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOVA",
        "first_name": "TRACY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-14",
        "last_updated": "2014-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "00676527",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "338872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Bates, RN, NP
• Hannah Beasock
• Sandra Patrick Beasock, P.T.
• Leah Boek, MSN FNP-BC
• Boonville Ambulance Inc.
• Katrina Denise Brownell, LPN
• Thomas Nicholas Caruso, DDS
• Mandi Ann Croniser, N.D.
• Melissa Damuth
• Elizabeth Ann Davis, LCSW-R, CASAC

• Family Nurse Practitioner in Boonville, NY
• Providers in Boonville, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.