| Doctor Name: | DR. TRACY S FANSLER MD LLC |
| NPI Number: | 1164572806 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | ME68721 |
| Business Practice Address: | 12955 Seminole Blvd Largo, FL - 337782399 |
| Business Phone Number: | 7275489500 |
| Business Fax Number: | 7275849502 |
| Mailing Address: | 13200 72nd Ave, SEMINOLE |
| State: | FL |
| Postal Code: | 337764213 |
| Phone Number: | 7273991955 |
| Fax Number: | |
| NPI Enumeration Date: | 01/12/2007 |
| NPI Last Update Date: | 09/14/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | ME68721 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |