Healthcare Provider Details

I. General information

NPI: 1831625805
Provider Name (Legal Business Name): TRACY NOGLE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7243 DELLA DR STE 1
ORLANDO FL
32819-5104
US

IV. Provider business mailing address

7243 DELLA DR STE 1
ORLANDO FL
32819-5104
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-5851
  • Fax:
Mailing address:
  • Phone: 321-843-5851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101025655
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS15631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: