Provider Demographics
NPI:1144956418
Name:TRACY, SUE-ANN-MARIE SCOTT (APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SUE-ANN-MARIE
Middle Name:SCOTT
Last Name:TRACY
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:MS
Other - First Name:SUE-ANN-MARIE
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SAM TRACY
Mailing Address - Street 1:6431 N W ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-1719
Mailing Address - Country:US
Mailing Address - Phone:251-379-7229
Mailing Address - Fax:
Practice Address - Street 1:6431 N W ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-1719
Practice Address - Country:US
Practice Address - Phone:850-494-4600
Practice Address - Fax:855-901-2936
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9314446163W00000X
AL1-180560163W00000X
FLAPRN11019114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse