Provider Demographics
NPI:1548909237
Name:DANIELS, TRACY ANN (HOME HEALTH AIDE)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ANN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:ANN HAYNES
Other - Last Name:LASANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAREGIVER
Mailing Address - Street 1:168 CROWN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-9018
Mailing Address - Country:US
Mailing Address - Phone:937-520-1679
Mailing Address - Fax:
Practice Address - Street 1:168 CROWN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-9018
Practice Address - Country:US
Practice Address - Phone:937-520-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health