Provider Demographics
NPI:1225329337
Name:ALTIDOR, TRACEY (ARNP)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:
Last Name:ALTIDOR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 NE 2ND AVE
Mailing Address - Street 2:8260 N.E 2ND AVENUE
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-3808
Mailing Address - Country:US
Mailing Address - Phone:305-757-9555
Mailing Address - Fax:
Practice Address - Street 1:8260 NE 2ND AVE
Practice Address - Street 2:8260 N.E 2ND AVENUE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-3808
Practice Address - Country:US
Practice Address - Phone:305-757-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-23
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9226295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily