Individual provider Active NPI

Tracey Ellison Taylor, PSY.D., LP

  • Clinical Psychologist
  • Brandon, FL
National Provider Identifier
1902294804
Registry record updated Dec 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY8204 Issued in FL
Practice address
615 Oakfield Dr
Brandon, FL 33511-5714
Phone
(833) 769-3524
NPI assigned
Dec 30, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY8204 FL Primary

Addresses

Primary practice location

615 Oakfield Dr
Brandon, FL 33511-5714

Mailing address

615 Oakfield Dr
Brandon, FL 33511-5714
Phone (833) 769-3524

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150430002115 FL Practitioner - Clinical Psychologist 9032438742 Reassigns benefits to 2 organizations
Practice locations: Tampa, FL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Personal Recovery Network LLCGroup PAC ID 5092611384, 612 clinicians

Practice addresses (Care Compare)

260 Lookout PL
Maitland, FL 32751-4485

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Cotler Healthcare & Development Inc. Clinical CurrentSince Jul 1, 2018 Accepting new patients
Personal Recovery Network LLC CurrentSince Oct 19, 2020 Accepting new patients

Locations

615 Oakfield Dr
Brandon, FL 33511
Phone (813) 565-3322

901 S 62nd Ave
Hollywood, FL 33023
Phone (954) 893-0109

9835 Lake Worth Rd
Ste 16179
Lake Worth, FL 33467

260 Lookout Pl
Ste 202
Maitland, FL 32751
Phone (407) 537-9450

6767 86th Ave N
Pinellas Park, FL 33782
Phone (727) 548-5566

5601 31st St S
St Petersburg, FL 33712
Phone (727) 848-3578

250 Corporate Center Ct
Stockbridge, GA 30281
Phone (770) 954-8685

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1419897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767052800000",
    "number": "1902294804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 OAKFIELD DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115714",
            "telephone_number": "833-769-3524",
            "fax_number": "813-200-9860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 OAKFIELD DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115714",
            "telephone_number": "833-769-3524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON TAYLOR",
        "first_name": "TRACEY",
        "name_prefix": "Dr.",
        "credential": "PSY.D., LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-30",
        "last_updated": "2025-12-30",
        "certification_date": "2025-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY8204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.