Provider Demographics
NPI:1558190561
Name:HERRES, TRACEY LEIGH (CPHT)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LEIGH
Last Name:HERRES
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 S CYPRESS BEND DR # 6-404
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-5633
Mailing Address - Country:US
Mailing Address - Phone:754-289-0395
Mailing Address - Fax:
Practice Address - Street 1:11449 W PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2659
Practice Address - Country:US
Practice Address - Phone:561-962-4006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT66339156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist