Provider Demographics
NPI:1235478272
Name:BELUSCAK, TRACY LYNNE (ARNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNNE
Last Name:BELUSCAK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYNNE
Other - Last Name:SEMANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8773 PERIMETER PARK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1165
Mailing Address - Country:US
Mailing Address - Phone:904-493-3390
Mailing Address - Fax:904-493-3395
Practice Address - Street 1:8773 PERIMETER PARK CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1165
Practice Address - Country:US
Practice Address - Phone:904-493-3390
Practice Address - Fax:904-493-3395
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2956842363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45681OtherMEDICARE - GROUP
FLY0FX5OtherFLORIDA BLUE
FLGZ318ZOtherMEDICARE - INDIVIDUAL
FLP01202776OtherRR MEDICARE