Healthcare Provider Details

I. General information

NPI: 1649222324
Provider Name (Legal Business Name): TRACI ASHCRAFT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

501 6TH AVE S
ST PETERSBURG FL
33701-4634
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-4222
  • Fax: 727-767-2880
Mailing address:
  • Phone: 727-767-4222
  • Fax: 727-767-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9114750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: