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General NPI Number Information
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NPI Number | 1356962211
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Entity Type | Individual
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Provider Name | TRACEY LY PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/01/2020
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 600 GRESHAM DR STE 700
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City | NORFOLK
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State | VA
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Zip | 23507-1904
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Country | US
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Telephone | 757-388-1700
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Fax | 423-826-1290
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Provider Business Mailing Address
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Address Line | 6275 E VIRGINIA BEACH BLVD STE 300
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City | NORFOLK
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State | VA
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Zip | 23502-2851
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Country | US
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Telephone | 757-466-0089
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Fax | 757-466-8017
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 58446
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110009247
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License Number State | VA
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