Provider Demographics
NPI:1659690592
Name:GREEN, TRACY EYVETTE (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:EYVETTE
Last Name:GREEN
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3546 BRICKELL CT
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-8807
Mailing Address - Country:US
Mailing Address - Phone:813-610-6737
Mailing Address - Fax:813-849-9946
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD # 124
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-849-9946
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9193953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily