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General NPI Number Information
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NPI Number | 1003343138
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Entity Type | Individual
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Provider Name | TRACY JACINDA BRANCH PA
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Gender | Female
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 05/19/2017
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Provider Practice Location Address
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Address Line | 8501 PLUM CREEK DR
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City | GAITHERSBURG
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State | MD
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Zip | 20882-4438
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Country | US
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Telephone | 240-246-7510
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Fax |
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Provider Business Mailing Address
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Address Line | 5600 FISHERS LN # 16N164C
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City | ROCKVILLE
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State | MD
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Zip | 20852-1750
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Country | US
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Telephone | 301-443-0494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 007573
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License Number State | NY
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