Healthcare Provider Details

I. General information

NPI: 1861780207
Provider Name (Legal Business Name): TRACY ANN DEPAOLA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SE OSCEOLA ST SUITE 301
STUART FL
34994-2301
US

IV. Provider business mailing address

501 SE OSCEOLA ST STE 301
STUART FL
34994-2347
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-5955
  • Fax:
Mailing address:
  • Phone: 772-878-7308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: