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General NPI Number Information
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NPI Number | 1659617280
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Entity Type | Individual
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Provider Name | TRACY ANN DEVITT ARNP
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Gender | Female
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Dates
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Enumeration Date | 01/01/2013
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Last Update Date | 01/18/2014
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Provider Practice Location Address
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Address Line | 152 FRONT ST
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City | PONTE VEDRA
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State | FL
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Zip | 32082-3058
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Country | US
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Telephone | 781-589-8603
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Fax |
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Provider Business Mailing Address
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Address Line | 3737 SAINT JOHNS BLUFF RD S APT 1616
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City | JACKSONVILLE
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State | FL
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Zip | 32224-2652
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Country | US
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Telephone | 781-589-8603
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9369018
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2271523
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License Number State | MA
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