Provider Demographics
NPI:1235893413
Name:WULFF, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WULFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 W ELIZABETH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-3855
Mailing Address - Country:US
Mailing Address - Phone:540-564-5100
Mailing Address - Fax:
Practice Address - Street 1:136 W ELIZABETH ST STE 102
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-3855
Practice Address - Country:US
Practice Address - Phone:540-564-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008317363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant