Provider Demographics
NPI:1720338569
Name:SALBER, TRACIE THOMPSON (PNP, ARNP)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:THOMPSON
Last Name:SALBER
Suffix:
Gender:F
Credentials:PNP, ARNP
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:
Other - Last Name:BRACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PNP, ARNP
Mailing Address - Street 1:110 S WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3546
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:407-905-8998
Practice Address - Street 1:840 MERCY DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7820
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:407-905-8998
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2527812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner