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General NPI Number Information
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NPI Number | 1396986360
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Entity Type | Individual
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Provider Name | TRACI HARP ELLISON PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/20/2009
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 1950 GLENN MITCHELL DR STE 102
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-0019
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Country | US
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Telephone | 757-368-0437
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Fax |
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Provider Business Mailing Address
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Address Line | 6350 CENTER DR
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City | NORFOLK
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State | VA
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Zip | 23502-4107
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Country | US
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Telephone | 757-905-5558
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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 | 0110002964
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License Number State | VA
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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 | PA08123
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License Number State | TX
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