Provider Demographics
NPI:1245784552
Name:PETTIGREW, TRACI (AP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:PETTIGREW
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3601 SW 2ND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2865
Mailing Address - Country:US
Mailing Address - Phone:352-727-7070
Mailing Address - Fax:352-727-7072
Practice Address - Street 1:4001 NEWBERRY RD A3
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-727-7070
Practice Address - Fax:352-727-7072
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAP3443171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist