Healthcare Provider Details

I. General information

NPI: 1548491707
Provider Name (Legal Business Name): TRACEY LEE TONSOR PA-C, M.P.A.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACEY TONSOR BROWNBACK PA-C, M.P.A.S.

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 EXECUTIVE DR
DANVILLE VA
24541-4100
US

IV. Provider business mailing address

158 EXECUTIVE DR
DANVILLE VA
24541-4100
US

V. Phone/Fax

Practice location:
  • Phone: 434-791-1088
  • Fax: 434-799-8525
Mailing address:
  • Phone: 434-791-1088
  • Fax: 434-799-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003020
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: