Provider Demographics
NPI:1942219464
Name:CARR, TRACY LYNN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:CARR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 DREW ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3310
Mailing Address - Country:US
Mailing Address - Phone:727-461-1543
Mailing Address - Fax:727-449-0594
Practice Address - Street 1:2370 DREW ST
Practice Address - Street 2:UNIT B
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3310
Practice Address - Country:US
Practice Address - Phone:727-461-1543
Practice Address - Fax:727-449-0594
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3282812363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306833100Medicaid
FL3282812OtherARNP LICENSE NUMBER