Healthcare Provider Details

I. General information

NPI: 1417834110
Provider Name (Legal Business Name): DR TRACIS HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 E HENRY AVE
TAMPA FL
33604-7143
US

IV. Provider business mailing address

904 E HENRY AVE
TAMPA FL
33604-7143
US

V. Phone/Fax

Practice location:
  • Phone: 813-510-5105
  • Fax:
Mailing address:
  • Phone: 813-510-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACI LYNN THOMPSON
Title or Position: CEO
Credential:
Phone: 813-510-5105