Individual
TRACIE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2 TAMPA GENERAL CIR FL 5, TAMPA, FL 33606-3603
(813) 215-6501
Mailing address
2 TAMPA GENERAL CIR, TAMPA, FL 33606-3603
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND7957
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KB4R1
BLUE CROSS BLUE SHIELD
FL
01
—
LI614
MEDICARE
FL
Enumeration date
05/29/2019
Last updated
07/17/2019
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