Healthcare Provider Details

I. General information

NPI: 1114684230
Provider Name (Legal Business Name): ZARI IFE TRACY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13470 PLAZA ROAD EXT
CHARLOTTE NC
28215-8924
US

IV. Provider business mailing address

405 HILO DR APT H
CHARLOTTE NC
28206-4975
US

V. Phone/Fax

Practice location:
  • Phone: 980-580-2554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2841889
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: