Healthcare Provider Details

I. General information

NPI: 1134071103
Provider Name (Legal Business Name): TRACY TYLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SE SALERNO RD
STUART FL
34997-6405
US

IV. Provider business mailing address

900 SE SALERNO RD
STUART FL
34997-6405
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-7853
  • Fax: 772-221-1794
Mailing address:
  • Phone: 772-223-7853
  • Fax: 772-221-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW8481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: