Healthcare Provider Details

I. General information

NPI: 1497859110
Provider Name (Legal Business Name): TRACY REED HAUKE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY REED NAYLOR FNP

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

V. Phone/Fax

Practice location:
  • Phone: 407-650-1300
  • Fax: 407-650-1307
Mailing address:
  • Phone: 407-650-1300
  • Fax: 407-650-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number128677
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number128677
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number000201887
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9370083
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: