Healthcare Provider Details

I. General information

NPI: 1811258239
Provider Name (Legal Business Name): TRACY L SHIPE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 PINE ST
LEESBURG FL
34748-6047
US

IV. Provider business mailing address

70 S DANLEY DR
FORT MYERS FL
33907-2437
US

V. Phone/Fax

Practice location:
  • Phone: 352-326-5961
  • Fax: 352-365-6438
Mailing address:
  • Phone: 239-533-6339
  • Fax: 239-277-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberOS14400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: