Provider Demographics
NPI:1417326513
Name:DAVE, TRACY ANN (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:DAVE
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:HASSAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 HUNTERS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6901
Mailing Address - Country:US
Mailing Address - Phone:407-857-2502
Mailing Address - Fax:407-857-1855
Practice Address - Street 1:3000 HUNTERS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6901
Practice Address - Country:US
Practice Address - Phone:407-857-2502
Practice Address - Fax:407-857-1855
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9325635363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner