Provider Demographics
NPI:1114626314
Name:RUTHERFORD, TRACY GAYLE (APRN)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:GAYLE
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 BAY ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5008
Mailing Address - Country:US
Mailing Address - Phone:727-365-3700
Mailing Address - Fax:
Practice Address - Street 1:731 BAY ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5008
Practice Address - Country:US
Practice Address - Phone:727-365-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9168347163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management