Active NPI
Tracey E Kock, ITDS
- Developmental Therapist
- Land O Lakes, FL
National Provider Identifier
1558624312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 21113 Lake Talia Blvd
Land O Lakes, FL 34638-3738 - Phone
- (813) 873-1936
- Fax
- (813) 873-8837
- NPI assigned
- Jun 18, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 007369 | SC | |
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
21113 Lake Talia Blvd
Land O Lakes, FL 34638-3738
Mailing address
21113 Lake Talia Blvd
Land O Lakes, FL 34638-3738
Phone (813) 873-1936
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 |
|---|---|---|---|
| 007369 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339977600000",
"number": "1558624312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21113 LAKE TALIA BLVD",
"city": "LAND O LAKES",
"state": "FL",
"postal_code": "346383738",
"telephone_number": "813-873-1936",
"fax_number": "813-873-8837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21113 LAKE TALIA BLVD",
"city": "LAND O LAKES",
"state": "FL",
"postal_code": "346383738",
"telephone_number": "813-873-1936",
"fax_number": "813-873-8837"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOCK",
"first_name": "TRACEY",
"middle_name": "E",
"name_prefix": "Ms.",
"credential": "ITDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-18",
"last_updated": "2012-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "SC",
"license": "007369",
"primary": false
},
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Land O Lakes, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.