Provider Information for 1487171799
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TRACY HALLORAN HILL
Sex: Female
NPI: 1487171799
Last Updated: 2018-06-16
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1487171799 | ||||||||
| Enumeration Date | 2017-08-28 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 992 PENNEY FARMS, FL 32079-0992 United States Phone: 904-579-6292 | Fax: | ||||||||
| Primary Practice Address | 406 MCINTOSH AVE ORANGE PARK, FL 32073-4834 United States Phone: 904-375-1243 | Fax: | ||||||||
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