Healthcare Provider Details

I. General information

NPI: 1548972730
Provider Name (Legal Business Name): TRACY-ANN DAMIELA HUTCHINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 N TRAVELERS PALM LN
TAMARAC FL
33319-3160
US

IV. Provider business mailing address

4901 N TRAVELERS PALM LN
TAMARAC FL
33319-3160
US

V. Phone/Fax

Practice location:
  • Phone: 954-901-5440
  • Fax:
Mailing address:
  • Phone: 954-901-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406010
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11023573
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: