Provider Demographics
NPI:1659617280
Name:DEVITT, TRACY ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:DEVITT
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 1:3737 SAINT JOHNS BLUFF RD S
Mailing Address - Street 2:APT 1616
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2652
Mailing Address - Country:US
Mailing Address - Phone:781-589-8603
Mailing Address - Fax:
Practice Address - Street 1:152 FRONT ST
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-3058
Practice Address - Country:US
Practice Address - Phone:781-589-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-01
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9369018363LF0000X
MARN2271523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily