Provider Demographics
NPI:1659996247
Name:MORGAN, TRACY ANN (CNA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 SW BURLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4351
Mailing Address - Country:US
Mailing Address - Phone:772-342-6274
Mailing Address - Fax:
Practice Address - Street 1:2042 SW BURLINGTON ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4351
Practice Address - Country:US
Practice Address - Phone:772-342-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA343222374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide