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General NPI Number Information
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NPI Number | 1841543063
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Entity Type | Individual
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Provider Name | TRACI CELESTE DIPHILLIPPO PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 4060 SHERIDAN ST STE C
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3559
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Country | US
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Telephone | 954-987-7512
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Fax | 954-987-3977
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Provider Business Mailing Address
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Address Line | 2235 VENETIAN COURT SUITE 1
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City | NAPLES
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State | FL
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Zip | 34109-8728
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Country | US
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Telephone | 239-596-9337
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Fax | 239-596-9466
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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 | PA9107681
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License Number State | FL
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