MEDICARE: TRACEY LUCINDA TAYLOR CRNP

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	363LA2100X	Acute Care Nurse Practitioner	APN0000011846	TN
2	363LA2100X	Acute Care Nurse Practitioner	1-127834	AL

General Provider Information

NPI Number	:	1518945245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY LUCINDA TAYLOR CRNP

Provider Business Mailing Address
First Line	:	PO BOX 40010
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36640-0010
Country	:	US
Telephone Number	:	251-471-7944
Fax Number	:	251-471-7451

Provider Business Practice Location Address
First Line	:	2451 FILLINGIM ST
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36617-2238
Country	:	US
Telephone Number	:	251-471-7000
Fax Number	:

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	12/01/2016

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