Provider Demographics
NPI:1659793172
Name:SEGREE, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SEGREE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 KILLEARN CENTER BLVD
Mailing Address - Street 2:APT#C72
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3518
Mailing Address - Country:US
Mailing Address - Phone:646-919-2140
Mailing Address - Fax:
Practice Address - Street 1:2305 KILLEARN CENTER BLVD
Practice Address - Street 2:APT#C72
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3518
Practice Address - Country:US
Practice Address - Phone:646-919-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA24022171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor