Provider Demographics
NPI:1164572806
Name:FANSLER MD LLC, TRACY S (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:S
Last Name:FANSLER MD LLC
Suffix:
Gender:F
Credentials:MD
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 9100
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9100
Mailing Address - Country:US
Mailing Address - Phone:561-300-2410
Mailing Address - Fax:
Practice Address - Street 1:11200 SEMINOLE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33778-3239
Practice Address - Country:US
Practice Address - Phone:727-306-2525
Practice Address - Fax:727-202-8196
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68721207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261667000Medicaid
FLK6258Medicare ID - Type Unspecified
FLF93835Medicare UPIN