Healthcare Provider Details

I. General information

NPI: 1104705086
Provider Name (Legal Business Name): TRACY KING DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 SE INDIAN ST
STUART FL
34997-5765
US

IV. Provider business mailing address

8815 CONROY WINDERMERE RD # 292
ORLANDO FL
32835-3129
US

V. Phone/Fax

Practice location:
  • Phone: 877-978-3125
  • Fax:
Mailing address:
  • Phone: 407-552-7136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11041568
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11041568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: