Individual
TRACEY FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
50 N LAURA ST STE 2560, JACKSONVILLE, FL 32202-3664
(904) 525-0308
(904) 302-8749
Mailing address
50 N LAURA ST STE 2560, JACKSONVILLE, FL 32202-3664
(904) 440-3602
(904) 302-8749
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5224459
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106251000
—
FL
Enumeration date
07/14/2020
Last updated
07/14/2020
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