Healthcare Provider Details

I. General information

NPI: 1558656694
Provider Name (Legal Business Name): TRACEY CAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 7TH ST N
NAPLES FL
34102-5754
US

IV. Provider business mailing address

350 7TH ST N
NAPLES FL
34102-5754
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-8015
  • Fax: 239-624-8101
Mailing address:
  • Phone: 239-624-8015
  • Fax: 239-624-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME120699
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: