Provider Demographics
NPI:1114275799
Name:MORGAN, TRACY C (B,S,W,)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:C
Last Name:MORGAN
Suffix:
Gender:F
Credentials:B,S,W,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 82ND AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-6992
Mailing Address - Country:US
Mailing Address - Phone:772-778-7217
Mailing Address - Fax:772-778-5006
Practice Address - Street 1:1910 82ND AVE STE 202
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-6992
Practice Address - Country:US
Practice Address - Phone:772-778-7217
Practice Address - Fax:772-778-5006
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator