MEDICARE: TYRA MCRAE

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	251S00000X	Community/Behavioral Health Agency	240586	FL
2	251S00000X	Community/Behavioral Health Agency	240878	FL
3	251S00000X	Community/Behavioral Health Agency	240937	FL

General Provider Information

NPI Number	:	1902323249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRA MCRAE

Provider Business Mailing Address
First Line	:	5005 W LAUREL ST STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-3896
Country	:	US
Telephone Number	:	561-501-0998
Fax Number	:

Provider Business Practice Location Address
First Line	:	12308 BREAPHITT CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-2695
Country	:	US
Telephone Number	:	561-501-0998
Fax Number	:

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

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	09/16/2025

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Directions to “ TYRA MCRAE ” Practice Location

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