Provider Demographics
NPI:1386135234
Name:PLAIR, TRACY LYNELL
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNELL
Last Name:PLAIR
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 1:5130 PALM PARK CT UNIT 206
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-4053
Mailing Address - Country:US
Mailing Address - Phone:813-793-1495
Mailing Address - Fax:
Practice Address - Street 1:5130 PALM PARK CT UNIT 206
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4053
Practice Address - Country:US
Practice Address - Phone:813-793-1495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-27
Last Update Date:2018-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty