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General NPI Number Information
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NPI Number | 1508286212
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Entity Type | Individual
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Provider Name | TRACY S. ERVIN
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Gender | Female
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 580 W 8TH ST BOX T-11
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6533
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Country | US
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Telephone | 904-244-3990
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Fax |
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Provider Business Mailing Address
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Address Line | 388 SW 62ND BLVD APT 7
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City | GAINESVILLE
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State | FL
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Zip | 32607-2050
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Country | US
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Telephone | 740-334-7385
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | ARNP9328203
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License Number State | FL
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