Provider Demographics
NPI:1497369359
Name:AARON, TRACIE LADELL
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:LADELL
Last Name:AARON
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 1:1076 MOOSEHEAD DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5235
Mailing Address - Country:US
Mailing Address - Phone:334-235-2926
Mailing Address - Fax:
Practice Address - Street 1:6824 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-4471
Practice Address - Country:US
Practice Address - Phone:904-710-7237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9468495163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse