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General NPI Number Information
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NPI Number | 1417834110
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Entity Type | Organization
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Legal Business Name | DR TRACIS HOUSE
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 904 E HENRY AVE
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City | TAMPA
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State | FL
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Zip | 33604-7143
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Country | US
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Telephone | 813-510-5105
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Fax |
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Provider Business Mailing Address
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Address Line | 904 E HENRY AVE
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City | TAMPA
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State | FL
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Zip | 33604-7143
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Country | US
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Telephone | 813-510-5105
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TRACI LYNN THOMPSON
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Credential |
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Telephone | 813-510-5105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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