Provider Demographics
NPI:1023313954
Name:HARTIG, TRACY L (PSYD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:L
Last Name:HARTIG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 E SUMMERLIN ST
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-4641
Mailing Address - Country:US
Mailing Address - Phone:863-533-6471
Mailing Address - Fax:
Practice Address - Street 1:158 E SUMMERLIN ST
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4641
Practice Address - Country:US
Practice Address - Phone:863-533-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6030103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic