Provider Demographics
NPI:1427555838
Name:RAPP, TRACY JESSICA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:JESSICA
Last Name:RAPP
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 PORT MALABAR BLVD NE STE 6
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5153
Mailing Address - Country:US
Mailing Address - Phone:321-727-9063
Mailing Address - Fax:321-728-1955
Practice Address - Street 1:1051 PORT MALABAR BLVD NE STE 6
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5153
Practice Address - Country:US
Practice Address - Phone:321-727-9063
Practice Address - Fax:321-728-1955
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9319991363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily