Provider Demographics
NPI:1114626314
Name:RUTHERFORD, TRACY GAYLE (APRN)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:GAYLE
Last Name:RUTHERFORD
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:13220 BELCHER RD S UNIT 11
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1678
Practice Address - Country:US
Practice Address - Phone:727-533-2242
Practice Address - Fax:727-533-2252
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11030105363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology