Provider Demographics
NPI:1093773970
Name:FOY, TRA'CHELLA J (MD)
Entity Type:Individual
Prefix:
First Name:TRA'CHELLA
Middle Name:J
Last Name:FOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRA'CHELLA
Other - Middle Name:C
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 45443
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84145-0443
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:124 E ASHLEY ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-3118
Practice Address - Country:US
Practice Address - Phone:904-353-5696
Practice Address - Fax:904-353-2844
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271531700Medicaid
FL57858OtherBCBS
FL271531700Medicaid
FL57858OtherBCBS
FL57858WMedicare UPIN
FL57858XMedicare PIN