Provider Demographics
NPI:1700193737
Name:GREENE, TRACY (NP-C)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:531 MAIN ST
Mailing Address - Street 2:STE K
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3558
Mailing Address - Country:US
Mailing Address - Phone:727-831-8376
Mailing Address - Fax:727-265-3420
Practice Address - Street 1:531 MAIN ST
Practice Address - Street 2:STE K
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3558
Practice Address - Country:US
Practice Address - Phone:727-831-8376
Practice Address - Fax:727-265-3420
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11672-NP363LF0000X
FLARNP9384048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CONP37292Medicare PIN