Active NPI
Tracy Zaneta Nelson, OWNER
- In Home Supportive Care Agency
- Fort Myers, FL
National Provider Identifier
1073025409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- In Home Supportive Care Agency
- License
- 234643
- Practice address
- 5624 7TH Ave
Fort Myers, FL 33907-2927 - Phone
- (561) 939-9510
- NPI assigned
- Oct 25, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| In Home Supportive Care Agency | 253Z00000X | 234643 | FL | Primary |
Addresses
Primary practice location
5624 7TH Ave
Fort Myers, FL 33907-2927
Mailing address
2135 Davis St
Fort Myers, FL 33916-4413
Phone (239) 355-0686
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 234643 | FL | MD | In Home Supportive Care Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678665600000",
"number": "1073025409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2135 DAVIS ST",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339164413",
"telephone_number": "239-355-0686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5624 7TH AVE",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339072927",
"telephone_number": "561-939-9510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "TRACY",
"middle_name": "ZANETA",
"credential": "OWNER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-25",
"last_updated": "2023-03-13",
"certification_date": "2023-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": "FL",
"license": "234643",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.