Provider Demographics
NPI:1417388612
Name:ROMANELLO, TRACY (DO)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:ROMANELLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S LAKE DASHA DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3132
Mailing Address - Country:US
Mailing Address - Phone:954-383-7166
Mailing Address - Fax:
Practice Address - Street 1:14875 NW 77TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2568
Practice Address - Country:US
Practice Address - Phone:305-351-7139
Practice Address - Fax:305-824-0665
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12424207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine