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NPI Code Detail

MEDICARE: MS. TRACEY J EISMONT PA

MEDICARE: MS. TRACEY J EISMONT PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA3182FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
29700123003OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA0003182OTHERFLRRMCR

General Provider Information

NPI Number : 1275529539
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TRACEY J EISMONT PA
Provider Business Mailing Address
First Line : PO BOX 863026
Second Line :
City : ORLANDO
State : FL
Zip : 32886-3026
Country : US
Telephone Number : 800-288-8325
Fax Number : 419-866-5453
Provider Business Practice Location Address
First Line : 1 SHIRCLIFF WAY
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-4748
Country : US
Telephone Number : 904-308-7300
Fax Number : 904-346-0113
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 01/11/2013

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