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General NPI Number Information
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NPI Number | 1578918363
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Entity Type | Individual
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Provider Name | ELIZABETH ANN TRACY PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 1500 N 28TH ST
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City | RICHMOND
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State | VA
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Zip | 23223-5332
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Country | US
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Telephone | 804-225-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 824 WINTHROPE DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-3938
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Country | US
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Telephone | 757-339-1004
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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 | 0110005291
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License Number State | VA
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