=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144956418
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUE-ANN-MARIE SCOTT TRACY APRN, FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2022
-----------------------------------------------------
Last Update Date | 08/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6431 N W ST
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32505-1719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-494-4600
-----------------------------------------------------
Fax | 855-901-2936
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6431 N W ST
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32505-1719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-379-7229
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN9314446
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 1-180560
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11019114
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------