Provider Demographics
NPI:1487520268
Name:MASSEY, TRACIE L
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:L
Last Name:MASSEY
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 1:1900 S HARBOR CITY BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4902
Mailing Address - Country:US
Mailing Address - Phone:321-321-2774
Mailing Address - Fax:
Practice Address - Street 1:1900 S HARBOR CITY BLVD STE 304
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4902
Practice Address - Country:US
Practice Address - Phone:321-321-2774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory