Healthcare Provider Details

I. General information

NPI: 1366422396
Provider Name (Legal Business Name): TRACY LEE MCMONIGLE PA-C /MPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US NAVAL HOSPITAL GUAM FARENHOLT AVE BLDG K-1
AGANA HTS GU
96919
US

IV. Provider business mailing address

US NAVAL HOSPITAL GUAM FARENHOLT AVE BLDG K-1
AGANA HTS GU
96919
US

V. Phone/Fax

Practice location:
  • Phone: 671-344-9619
  • Fax:
Mailing address:
  • Phone: 671-344-9619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: