Provider Demographics
NPI:1528413127
Name:JONES, TRACI (CST)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 NE COUNTY ROAD 400
Mailing Address - Street 2:
Mailing Address - City:MAYO
Mailing Address - State:FL
Mailing Address - Zip Code:32066-4261
Mailing Address - Country:US
Mailing Address - Phone:386-647-4221
Mailing Address - Fax:
Practice Address - Street 1:911 NE COUNTY ROAD 400
Practice Address - Street 2:
Practice Address - City:MAYO
Practice Address - State:FL
Practice Address - Zip Code:32066-4261
Practice Address - Country:US
Practice Address - Phone:386-647-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA117179246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist