Healthcare Provider Details

I. General information

NPI: 1831429257
Provider Name (Legal Business Name): TRACY TOFT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 24TH AVE NW
NORMAN OK
73069-6232
US

IV. Provider business mailing address

5300 N. INDEPENDENCE AVE SUITE 280
OKLAHOMA CITY OK
73112-2136
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-0555
  • Fax: 405-573-5464
Mailing address:
  • Phone: 405-364-0555
  • Fax: 405-573-5464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1892
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: