Provider Demographics
NPI:1104335355
Name:MARX-RENNER, TRACY (LPN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MARX-RENNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9148 DEMARET CT
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4617
Mailing Address - Country:US
Mailing Address - Phone:727-277-8732
Mailing Address - Fax:
Practice Address - Street 1:17921 HUNTING BOW CIR STE 101
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5379
Practice Address - Country:US
Practice Address - Phone:727-372-7371
Practice Address - Fax:727-372-4985
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5203286164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse