Provider Demographics
NPI: | 1003823428 |
---|---|
Name: | ZIELINSKI, TRACY HEATHER (APRN) |
Entity Type: | Individual |
Prefix: | |
First Name: | TRACY |
Middle Name: | HEATHER |
Last Name: | ZIELINSKI |
Suffix: | |
Gender: | F |
Credentials: | APRN |
Other - Prefix: | |
Other - First Name: | TRACY |
Other - Middle Name: | HEATHER |
Other - Last Name: | ZIELINSKI |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | APRN |
Mailing Address - Street 1: | 4219 LEMONGRASS DR |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT MYERS |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33916-8173 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 239-272-7705 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4219 LEMONGRASS DR |
Practice Address - Street 2: | |
Practice Address - City: | FORT MYERS |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33916-8173 |
Practice Address - Country: | US |
Practice Address - Phone: | 239-272-7705 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-01 |
Last Update Date: | 2022-06-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | APRN3217402 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 105187100 | Medicaid | |
P00238118 | Medicare ID - Type Unspecified | RAILROAD MEDICARE | |
Y060GW | Medicare ID - Type Unspecified |