Provider Demographics
NPI:1326208422
Name:SHERROD,, D. TRACY ANN (RN)
Entity Type:Individual
Prefix:
First Name:D.
Middle Name:TRACY ANN
Last Name:SHERROD,
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 WATERLAND CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8116
Mailing Address - Country:US
Mailing Address - Phone:407-207-6575
Mailing Address - Fax:407-208-0202
Practice Address - Street 1:745 WATERLAND CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8116
Practice Address - Country:US
Practice Address - Phone:407-207-6575
Practice Address - Fax:407-208-0202
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN-3239622171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679400968Medicaid
FL679400996Medicaid
FL679400998Medicaid