Provider Demographics
NPI:1518310432
Name:FLORIO, TRACEY
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:FLORIO
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:CMR 467 BOX 314
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09096-0004
Mailing Address - Country:US
Mailing Address - Phone:314-590-1498
Mailing Address - Fax:
Practice Address - Street 1:( FLUGPLATZ ERBENHEIM BLDG 1040,
Practice Address - Street 2:
Practice Address - City:WIESBADEN
Practice Address - State:HESSEN
Practice Address - Zip Code:65205
Practice Address - Country:DE
Practice Address - Phone:063719-464-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH6163124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist