Healthcare Provider Details

I. General information

NPI: 1265318059
Provider Name (Legal Business Name): TRACEY RUTH GARNER EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HERITAGE DR STE 210
JUPITER FL
33458-3097
US

IV. Provider business mailing address

13835 EMERSON ST UNIT 103
PALM BEACH GARDENS FL
33418-6086
US

V. Phone/Fax

Practice location:
  • Phone: 561-919-5242
  • Fax:
Mailing address:
  • Phone: 561-919-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number33826
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPGP-0702894
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS2023
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: