Healthcare Provider Details

I. General information

NPI: 1326847971
Provider Name (Legal Business Name): KADIA TRACEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 LINTON BLVD
DELRAY BEACH FL
33484-6596
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 561-808-0098
  • Fax: 561-496-0592
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11036403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: