Provider Demographics
NPI:1962058891
Name:GOLDBERG, TRACY (DNP)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:KAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12144 US HIGHWAY 301 N UNIT 101
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-8463
Mailing Address - Country:US
Mailing Address - Phone:941-350-7855
Mailing Address - Fax:
Practice Address - Street 1:217 CRYSTAL GROVE BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-6465
Practice Address - Country:US
Practice Address - Phone:813-454-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9386159163WC0200X
FLAPRN11007698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine