Provider Information for 1699164251
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
TRACY HACKER LCSW
Sex: Female
NPI: 1699164251
Last Updated: 2020-05-21
Certification Date: 2020-05-21
Certification Date: 2020-05-21
Details
Name | Value | ||||||||
---|---|---|---|---|---|---|---|---|---|
NPI | 1699164251 | ||||||||
Enumeration Date | 2015-01-20 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | YES | ||||||||
Status | Active | ||||||||
Mailing Address | 305 SKYLINE DR STE 1 LADY LAKE, FL 32159-4592 United States Phone: 352-451-1521 | Fax:352-431-3173 | ||||||||
Primary Practice Address | 1614 PALM WAY LARGO, FL 33771-3926 United States Phone: 727-437-6038 | Fax: | ||||||||
Secondary Practice Address(es) | |||||||||
Health Information Exchange |
| ||||||||
Other Identifiers |
| ||||||||
Taxonomy |
|