Healthcare Provider Details

I. General information

NPI: 1639624778
Provider Name (Legal Business Name): TRACY LEE EILERS APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE F NE STE 9118
WINTER HAVEN FL
33881-4131
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 863-297-1777
  • Fax: 863-297-1756
Mailing address:
  • Phone: 727-532-1355
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9234028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: