Healthcare Provider Details

I. General information

NPI: 1760161723
Provider Name (Legal Business Name): TRACY LYNN GAUCK DNP, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 GLENN MITCHELL DR STE 500
VIRGINIA BEACH VA
23456-0179
US

IV. Provider business mailing address

3245 CLUB HOUSE RD
VIRGINIA BEACH VA
23452-6503
US

V. Phone/Fax

Practice location:
  • Phone: 757-403-5020
  • Fax:
Mailing address:
  • Phone: 757-403-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024196346
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: