Healthcare Provider Details

I. General information

NPI: 1306163167
Provider Name (Legal Business Name): TRACEY CONREY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRACEY JARVIS BAILEY

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 GEORGE W ENGRAM BLVD
DAYTONA BEACH FL
32114-1859
US

IV. Provider business mailing address

868 GEORGE W ENGRAM BLVD
DAYTONA BEACH FL
32114-1859
US

V. Phone/Fax

Practice location:
  • Phone: 386-310-7879
  • Fax: 386-233-3313
Mailing address:
  • Phone: 386-310-7879
  • Fax: 386-233-3313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-07-3737
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: