Individual provider Active NPI

Tracy Ann Antoneth Spence, APRN, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Lauderdale, FL
National Provider Identifier
1952008757
Registry record updated Mar 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN11023811 Issued in FL
Practice address
4546 N Federal Hwy
Fort Lauderdale, FL 33308-5204
Phone
(954) 716-6514
Fax
(954) 564-1371
NPI assigned
Feb 13, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN9366980 FL
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN11023811 FL Primary

Addresses

Primary practice location

4546 N Federal Hwy
Fort Lauderdale, FL 33308-5204

Mailing address

4546 N Federal Hwy
Fort Lauderdale, FL 33308-5204
Phone (954) 716-6514

Other identifiers 1

IdentifierTypeStateIssuer
APRN11023811OtherFLSTATE LICENSE

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
I20230314000078 FL Practitioner - Nurse Practitioner 4284008343 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Theracounsel, Inc.Group PAC ID 0143206466, 17 clinicians

Practice addresses (Care Compare)

2808 NE 22ND St
Fort Lauderdale, FL 33305-2804

4546 N Federal Hwy
Fort Lauderdale, FL 33308-5204
Phone (954) 716-6514

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN9366980FLMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Psychiatric/Mental Health CurrentSince Feb 7, 2025 Accepting new patients
Theracounsel, Inc. CurrentSince Feb 21, 2023 Accepting new patients

Locations

4546 N Federal Hwy
Ft Lauderdale, FL 33308
Phone (954) 328-6163

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

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": "1676246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679184000000",
    "number": "1952008757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4546 N FEDERAL HWY",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333085204",
            "telephone_number": "954-716-6514",
            "fax_number": "954-564-1371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4546 N FEDERAL HWY",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333085204",
            "telephone_number": "954-716-6514",
            "fax_number": "954-564-1371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCE",
        "first_name": "TRACY",
        "middle_name": "ANN ANTONETH",
        "name_prefix": "Mrs.",
        "credential": "APRN, PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-13",
        "last_updated": "2023-03-19",
        "certification_date": "2023-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9366980",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11023811",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "APRN11023811",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.