Provider Demographics
NPI:1487783114
Name:WERTHEIM, TRACEY ANN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:ANN
Last Name:WERTHEIM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:ANN
Other - Last Name:KUVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2130 OVERVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655
Mailing Address - Country:US
Mailing Address - Phone:727-376-1516
Mailing Address - Fax:727-376-1532
Practice Address - Street 1:5400 SCHOOL ROAD
Practice Address - Street 2:COMPANY CARE
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652
Practice Address - Country:US
Practice Address - Phone:727-834-5908
Practice Address - Fax:727-834-5680
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1522082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner