Tracy Derryberry, R.N.

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN9417391 Issued in FL

Practice address

10110 Bahama Dr
Cutler Bay, FL 33189-1506

Phone

(305) 577-4840

Fax

(305) 400-6243

NPI assigned

Oct 30, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1446163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446163200000",
    "number": "1558733485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10110 BAHAMA DR",
            "city": "CUTLER BAY",
            "state": "FL",
            "postal_code": "331891506",
            "telephone_number": "305-577-4840",
            "fax_number": "305-400-6243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10110 BAHAMA DR",
            "city": "CUTLER BAY",
            "state": "FL",
            "postal_code": "331891506",
            "telephone_number": "305-577-4840",
            "fax_number": "305-400-6243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRYBERRY",
        "first_name": "TRACY",
        "name_prefix": "Mr.",
        "credential": "R.N.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-30",
        "last_updated": "2015-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9417391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "RN9417391",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Cutler Bay, FL
• Providers in Cutler Bay, FL by specialty
• Registered Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.