Healthcare Provider Details

I. General information

NPI: 1053379875
Provider Name (Legal Business Name): TRACY M COWART CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY M NIELSON CNM

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 01/17/2021
Certification Date: 01/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10524 MOSS PARK RD STE 204-603
ORLANDO FL
32832-5898
US

IV. Provider business mailing address

10107 AUTHORS WAY
ORLANDO FL
32832-6349
US

V. Phone/Fax

Practice location:
  • Phone: 407-974-7171
  • Fax:
Mailing address:
  • Phone: 407-446-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP 9311141
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: