Traci-Lyn Eisenberg, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS12703 Issued in FL

Practice address

3200 S University Dr
Davie, FL 33328-2018

Phone

(954) 262-4100

NPI assigned

Jun 22, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nova Southeastern University, Inc

  • Optometrist
  • Ft. Lauderdale, FL
  • NPI 1700924511
  Medicare reassignment NPD
• Nova Southeastern University Inc.

  • Clinical Medical Laboratory
  • Ft. Lauderdale, FL
  • NPI 1770533390
  NPD
• Nova Southeastern University, Inc

  • Optometrist
  • Davie, FL
  • NPI 1588802169
  NPD
• Nova Southeastern University, Inc

  • Family Medicine Physician
  • Davie, FL
  • NPI 1447345517
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484006400000",
    "number": "1053607630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 S UNIVERSITY DR",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333282018",
            "telephone_number": "954-262-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 S UNIVERSITY DR",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333282018",
            "telephone_number": "954-262-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISENBERG",
        "first_name": "TRACI-LYN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-22",
        "last_updated": "2017-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS12703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luisa F Egea, LMT
• Michael R Ehren, RPH, CPH
• Evlyn Isabel Eickhoff, MD
• Eileen Grove, LCSW, LLC
• Daniella Jean Einstein
• Joshua Eisenman, PHARMD, RPH
• Gabrielle F Eisler, MS
• Reem Ekhraiwesh
• Ime Marcella Ekong, PSYD
• Mohamad Muhieddine Lee El Dannaoui

• Family Medicine Physician in Davie, FL
• Providers in Davie, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.