Individual provider Active NPI

Tracy Jessica Rapp, ARNP

  • Family Nurse Practitioner
  • Palm Bay, FL
National Provider Identifier
1427555838
Registry record updated Mar 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP9319991 Issued in FL
Practice address
1051 Port Malabar Blvd NE Ste 6
Palm Bay, FL 32905-5153
Phone
(321) 727-9063
Fax
(321) 728-1955
NPI assigned
Apr 11, 2018
Last updated
Mar 15, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP9319991 FL Primary

Addresses

Primary practice location

1051 Port Malabar Blvd NE Ste 6
Palm Bay, FL 32905-5153

Mailing address

1051 Port Malabar Blvd NE Ste 6
Palm Bay, FL 32905-5153
Phone (321) 727-9063

Other practice location 1

1350 Hickory St
Melbourne, FL 32901-3224
Phone (321) 434-7000

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190228000405 FL Practitioner - Nurse Practitioner 1951640473

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP9319991FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Brevard Geriatrics, LLC CurrentSince Nov 28, 2023 Accepting new patients
Charles S. Theofilos MD PA PastSince Jan 28, 2019 Accepting new patients

Locations

720 E New Haven Ave
Ste 11
Melbourne, FL 32901
Phone (254) 236-5079

2225 Knox McRae Dr
Titusville, FL 32780
Phone (321) 267-0060

8050 Spyglass Rd
Viera, FL 32940
Phone (321) 752-1000

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552608000000",
    "number": "1427555838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 PORT MALABAR BLVD NE STE 6",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329055153",
            "telephone_number": "321-727-9063",
            "fax_number": "321-728-1955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 PORT MALABAR BLVD NE STE 6",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329055153",
            "telephone_number": "321-727-9063",
            "fax_number": "321-728-1955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1350 Hickory St",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329013224",
            "country_code": "US",
            "telephone_number": "321-434-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAPP",
        "first_name": "TRACY",
        "middle_name": "JESSICA",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-11",
        "last_updated": "2019-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9319991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Bay, FL

Sources for this page

Verify at the official NPI Registry.