Active NPI
Tracey Landrum
- Contractor
- Lake Mary, FL
National Provider Identifier
1649502824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- OTA10905
- Practice address
- 300 International Pkwy
Lake Mary, FL 32746-5035 - Phone
- (407) 732-5848
- NPI assigned
- Feb 12, 2010
- Last updated
- Feb 12, 2010
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Contractor | 171W00000X | OTA10905 | FL | Primary |
Addresses
Primary practice location
300 International Pkwy
Lake Mary, FL 32746-5035
Mailing address
37 Ocean Breeze Cir
Ormond Beach, FL 32176-2821
Phone (386) 290-7553
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 |
|---|---|---|---|
| OTA10905 | FL | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265932800000",
"number": "1649502824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37 OCEAN BREEZE CIR",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321762821",
"telephone_number": "386-290-7553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 INTERNATIONAL PKWY",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327465035",
"telephone_number": "407-732-5848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDRUM",
"first_name": "TRACEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-02-12",
"last_updated": "2010-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "FL",
"license": "OTA10905",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Mary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.