Provider Demographics
NPI:1457815136
Name:DASHER, TRACY ELLEN
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ELLEN
Last Name:DASHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 JENNINGS DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-5723
Mailing Address - Country:US
Mailing Address - Phone:863-582-2125
Mailing Address - Fax:
Practice Address - Street 1:1515 MICHELIN CT
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-7533
Practice Address - Country:US
Practice Address - Phone:813-949-8946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-26
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health