MEDICARE: MS. TRACEY ZAAKIRA MCKINNEY BAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255629093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACEY ZAAKIRA MCKINNEY BAS

Provider Business Mailing Address
First Line	:	1923 GREY FALCON CIR SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-8609
Country	:	US
Telephone Number	:	772-532-6289
Fax Number	:	772-675-1881

Provider Business Practice Location Address
First Line	:	1923 GREY FALCON CIR SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-8609
Country	:	US
Telephone Number	:	772-532-6289
Fax Number	:	772-675-1881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2011
Last Update Date	:	07/14/2011

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