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General NPI Number Information
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NPI Number | 1750318242
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Entity Type | Individual
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Provider Name | TRACY A. FENN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | LUMAR PLAZA, 1847 PSL BLVD WELLMED MEDICAL MANAGMENT OF FLORIDA, INC.
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City | PORT ST. LUCIE
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State | FL
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Zip | 94952
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Country | US
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Telephone | 772-579-2303
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Fax |
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Provider Business Mailing Address
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Address Line | 80 GRETA LN
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City | HENDERSON
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State | NC
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Zip | 27537-3475
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Country | US
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Telephone |
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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 |
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License Number State | NC
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