Healthcare Provider Details

I. General information

NPI: 1427555838
Provider Name (Legal Business Name): TRACY JESSICA RAPP ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 PORT MALABAR BLVD NE STE 6
PALM BAY FL
32905-5153
US

IV. Provider business mailing address

1051 PORT MALABAR BLVD NE STE 6
PALM BAY FL
32905-5153
US

V. Phone/Fax

Practice location:
  • Phone: 321-727-9063
  • Fax: 321-728-1955
Mailing address:
  • Phone: 321-727-9063
  • Fax: 321-728-1955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9319991
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: