MEDICARE: TRACI LYN VICARI APRN

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	363LF0000X	Family Nurse Practitioner	APRN2148942	FL

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

General Provider Information

NPI Number	:	1457358020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI LYN VICARI APRN

Provider Business Mailing Address
First Line	:	4823 SETH LN
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33565-6804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4823 SETH LN
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33565-6804
Country	:	US
Telephone Number	:	813-610-4244
Fax Number	:

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	09/25/2023

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