Basic Information
Provider Information
NPI: 1023387909
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BEST
FirstName: TRACY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1155 35TH LN STE 204
Address2:  
City: VERO BEACH
State: FL
PostalCode: 329606537
CountryCode: US
TelephoneNumber: 7725674311
FaxNumber: 7727941450
Practice Location
Address1: 1190 37TH ST
Address2:  
City: VERO BEACH
State: FL
PostalCode: 329606507
CountryCode: US
TelephoneNumber: 7725634666
FaxNumber: 7727702025
Other Information
ProviderEnumerationDate: 12/21/2011
LastUpdateDate: 08/02/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN9258361FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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