Provider Demographics
NPI:1053635722
Name:FRITZINGER, TRACEY RAE (RT(N), CNMT)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:RAE
Last Name:FRITZINGER
Suffix:
Gender:F
Credentials:RT(N), CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3455
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32721-3455
Mailing Address - Country:US
Mailing Address - Phone:386-956-8444
Mailing Address - Fax:
Practice Address - Street 1:680 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-2416
Practice Address - Country:US
Practice Address - Phone:386-956-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT 605152471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology