Provider Demographics
NPI:1003053919
Name:WHEELER, TRACY DENISE (CNA/ HHA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:DENISE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:CNA/ HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 LUCERNE PARK RD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-1666
Mailing Address - Country:US
Mailing Address - Phone:863-514-0994
Mailing Address - Fax:
Practice Address - Street 1:328 AVENUE B
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:FL
Practice Address - Zip Code:33877
Practice Address - Country:US
Practice Address - Phone:863-514-0994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA123933172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker