Provider Demographics
NPI:1306426580
Name:HAMILTON, TRACEY
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:HAMILTON
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 1:1909 HILLBROOKE TRL STE 4-5
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-7901
Mailing Address - Country:US
Mailing Address - Phone:850-274-5303
Mailing Address - Fax:850-274-5303
Practice Address - Street 1:1909 HILLBROOKE TRL STE 4-5
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-7901
Practice Address - Country:US
Practice Address - Phone:850-274-5303
Practice Address - Fax:850-274-5303
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL236675376J00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116606200Medicaid