Provider Demographics
NPI:1396115721
Name:CONNELL, TRACY KARLOW (ARNP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:KARLOW
Last Name:CONNELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LEE
Other - Last Name:KARLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5750 LAZY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-1744
Mailing Address - Country:US
Mailing Address - Phone:813-323-5114
Mailing Address - Fax:
Practice Address - Street 1:200 AVENUE F NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4131
Practice Address - Country:US
Practice Address - Phone:863-293-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2826402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily