Provider Demographics
NPI:1790482677
Name:HENRY, TRACEY-ANN NATALIE
Entity Type:Individual
Prefix:
First Name:TRACEY-ANN
Middle Name:NATALIE
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 HINCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-5927
Mailing Address - Country:US
Mailing Address - Phone:407-994-5880
Mailing Address - Fax:
Practice Address - Street 1:1725 HINCKLEY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-5927
Practice Address - Country:US
Practice Address - Phone:407-994-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service