Provider Demographics
NPI:1083848402
Name:FLETCHER, TRACY ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ANN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 NE 17TH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3948
Mailing Address - Country:US
Mailing Address - Phone:352-215-6602
Mailing Address - Fax:
Practice Address - Street 1:1920 NE 17TH DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3948
Practice Address - Country:US
Practice Address - Phone:352-215-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA54956225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist