Provider Demographics
NPI:1992844914
Name:DELUCIA, TRACEY A (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:A
Last Name:DELUCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 W DR MLK BLVD FL JR3
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6307
Mailing Address - Country:US
Mailing Address - Phone:813-554-8983
Mailing Address - Fax:813-443-8177
Practice Address - Street 1:3003 W DR MLK BLVD FL JR3
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6307
Practice Address - Country:US
Practice Address - Phone:813-554-8983
Practice Address - Fax:813-443-8177
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121117207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013082800Medicaid
FLHY412ZMedicare PIN