MEDICARE: DR. TRACY MICHELLE ECKLES DDS

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	122300000X	Dentist	DN013963	GA
2	122300000X	Dentist	DNCS000279	GA
3	122300000X	Dentist	DN20540	FL

General Provider Information

NPI Number	:	1598996597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY MICHELLE ECKLES DDS

Provider Business Mailing Address
First Line	:	3605 LONGFORD DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-3250
Country	:	US
Telephone Number	:	850-322-5320
Fax Number	:	850-848-9798

Provider Business Practice Location Address
First Line	:	1234 TIMBERLANE RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1710
Country	:	US
Telephone Number	:	850-656-5600
Fax Number	:

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

Provider Enumeration Date	:	08/07/2009
Last Update Date	:	08/28/2025

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