Provider Demographics
NPI:1689907651
Name:ROBERTS, TRACY LYNN (RRT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 JOHN SHARP RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2594
Mailing Address - Country:US
Mailing Address - Phone:931-446-5512
Mailing Address - Fax:
Practice Address - Street 1:1150 JOHN SHARP RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2594
Practice Address - Country:US
Practice Address - Phone:931-446-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ64452279C0205X
TN25402279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care