Provider Demographics
NPI:1427474410
Name:DZUGAN, TRACY MICHELLE (MS,FNP,PMHNP-BC,APRN)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:MICHELLE
Last Name:DZUGAN
Suffix:
Gender:F
Credentials:MS,FNP,PMHNP-BC,APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:2470 BLOOMINGDALE AVE STE 260
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6403
Practice Address - Country:US
Practice Address - Phone:833-674-2500
Practice Address - Fax:239-599-4126
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9364680363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011817700Medicaid
FL011817700Medicaid