Provider Demographics
NPI:1982493268
Name:CROFT, TRACY LEE I
Entity type:Individual
Prefix:MR
First Name:TRACY
Middle Name:LEE
Last Name:CROFT
Suffix:I
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 SHILOH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-0136
Mailing Address - Country:US
Mailing Address - Phone:850-843-2456
Mailing Address - Fax:
Practice Address - Street 1:1867 SHILOH CHURCH RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-0136
Practice Address - Country:US
Practice Address - Phone:850-843-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3627343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)