Healthcare Provider Details

I. General information

NPI: 1962058891
Provider Name (Legal Business Name): TRACY GOLDBERG DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. TRACY KAY

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 CRYSTAL GROVE BLVD
LUTZ FL
33548-6465
US

IV. Provider business mailing address

12144 US HIGHWAY 301 N UNIT 101
PARRISH FL
34219-8463
US

V. Phone/Fax

Practice location:
  • Phone: 813-454-4044
  • Fax:
Mailing address:
  • Phone: 941-350-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9386159
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11007698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: