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General NPI Number Information
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NPI Number | 1902323249
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Entity Type | Individual
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Provider Name | TYRA MCRAE
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Gender | Female
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 12308 BREAPHITT CT
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City | TAMPA
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State | FL
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Zip | 33626-2695
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Country | US
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Telephone | 561-501-0998
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Fax |
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Provider Business Mailing Address
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Address Line | 5005 W LAUREL ST STE 100
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City | TAMPA
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State | FL
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Zip | 33607-3896
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Country | US
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Telephone | 561-501-0998
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 240586
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 240878
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 240937
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License Number State | FL
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