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NPI Code Detail

MEDICARE: TRACEY LAVONE EARL ARNP

MEDICARE: TRACEY LAVONE EARL ARNP
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
1363LA2100XAcute Care Nurse Practitioner2845622FL

Other Identifiers

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

General Provider Information

NPI Number : 1508358219
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACEY LAVONE EARL ARNP
Provider Business Mailing Address
First Line : 6800 20TH AVE N APT 203
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33710-4797
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 PINELLAS ST
Second Line :
City : CLEARWATER
State : FL
Zip : 33756-3892
Country : US
Telephone Number : 727-462-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2018
Last Update Date : 05/30/2018

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