Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME121117 | FL |
NPI | 1992844914 |
---|---|
Provider Name | Dr. Tracey A. Delucia |
First Address | Clearwater, FL 33757-8744 |
Second Address | Tampa, FL 33607-6307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 17/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013082800 | (05) | FL |