Provider Demographics
NPI:1053379875
Name:COWART, TRACY M (CNM)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:M
Last Name:COWART
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:M
Other - Last Name:NIELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:10107 AUTHORS WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6349
Mailing Address - Country:US
Mailing Address - Phone:407-446-4041
Mailing Address - Fax:
Practice Address - Street 1:10524 MOSS PARK RD STE 204-603
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5898
Practice Address - Country:US
Practice Address - Phone:407-974-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9311141367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004153500Medicaid
FL004153500Medicaid
FL004153500Medicaid
FLFZ894ZMedicare PIN
NV100379Medicare PIN