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General NPI Number Information
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NPI Number | 1366947533
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Entity Type | Individual
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Provider Name | TRACY ANNE MIX PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 33300 CLEVELAND CLINIC BLVD
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City | AVON
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State | OH
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Zip | 44011-1172
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Country | US
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Telephone | 440-371-8395
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Fax |
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Provider Business Mailing Address
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Address Line | 27664 WESTCHESTER PKWY APT A
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City | WESTLAKE
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State | OH
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Zip | 44145-1216
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Country | US
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Telephone | 937-681-0383
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601008591
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License Number State | MI
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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 | 025684
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.005845RX
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License Number State | OH
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