Provider Demographics
NPI:1295712628
Name:DIGIACOMO, TRACY A (CRNA)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:A
Last Name:DIGIACOMO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:T
Other - Last Name:TROIANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4740 ENTERPRISE AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-7058
Mailing Address - Country:US
Mailing Address - Phone:239-404-0058
Mailing Address - Fax:239-774-5691
Practice Address - Street 1:1656 MEDICAL BLVD
Practice Address - Street 2:SUITE 201 PREMIER ENDOSCOPY
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110
Practice Address - Country:US
Practice Address - Phone:239-593-6201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX616594367500000X
PARN291599L367500000X
FL3163752367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62771Medicare ID - Type Unspecified