Active NPI
Tracy Shabu
- Gerontology Nurse Practitioner
- Cary, NC
National Provider Identifier
1194352963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 11180114
- Practice address
- 714 Windy Peak Loop
Cary, NC 27519-1886 - Phone
- (919) 914-4097
- NPI assigned
- Mar 23, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 11180114 | NC | Primary |
Addresses
Primary practice location
714 Windy Peak Loop
Cary, NC 27519-1886
Mailing address
714 Windy Peak Loop
Cary, NC 27519-1886
Phone (919) 914-4097
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11180114 | NC | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Theoria Medical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- Brighton, MI
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584921600000",
"number": "1194352963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "714 WINDY PEAK LOOP",
"city": "CARY",
"state": "NC",
"postal_code": "275191886",
"telephone_number": "919-914-4097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "714 WINDY PEAK LOOP",
"city": "CARY",
"state": "NC",
"postal_code": "275191886",
"telephone_number": "919-914-4097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHABU",
"first_name": "TRACY",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-23",
"last_updated": "2020-03-23",
"certification_date": "2020-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "NC",
"license": "11180114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cary, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.