Healthcare Provider Details

I. General information

NPI: 1891266730
Provider Name (Legal Business Name): DAVID SCOTT TRCKA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 ST. PETER AVE E
DELANO MN
55328-2813
US

IV. Provider business mailing address

5304 NICKLAUS DR NW
ROCHESTER MN
55901-3766
US

V. Phone/Fax

Practice location:
  • Phone: 952-442-7800
  • Fax:
Mailing address:
  • Phone: 507-259-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12867
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: