Provider Demographics
NPI:1093094393
Name:GAYLE, TRACEY ANN (CNA,HHA,LPN)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANN
Last Name:GAYLE
Suffix:
Gender:F
Credentials:CNA,HHA,LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 MALIBU BAY DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-8402
Mailing Address - Country:US
Mailing Address - Phone:561-723-7822
Mailing Address - Fax:
Practice Address - Street 1:735 MALIBU BAY DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-8402
Practice Address - Country:US
Practice Address - Phone:561-723-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLXXX000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health