Individual
MR. TRACY DERRYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.N.
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN9417391
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN9417391
RN LICENSE
FL
Enumeration date
10/30/2015
Last updated
10/30/2015
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