Individual
TRACIE ROULHAC BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1160 MOHAWK ST APT 1, JACKSONVILLE, FL 32205-0905
(904) 444-5214
Mailing address
1160 MOHAWK ST APT 1, JACKSONVILLE, FL 32205-0905
(904) 444-5214
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
FL
Other
Enumeration date
02/18/2019
Last updated
02/18/2019
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