Provider Demographics
NPI:1275568602
Name:COE, TRACY (PA)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:COE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 WINDCOM CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7886
Mailing Address - Country:US
Mailing Address - Phone:972-398-3500
Mailing Address - Fax:972-398-3512
Practice Address - Street 1:6100 WINDCOM CT
Practice Address - Street 2:SUITE 101
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7886
Practice Address - Country:US
Practice Address - Phone:972-398-3500
Practice Address - Fax:972-398-3512
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02292363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P66675Medicare UPIN
P66675Medicare UPIN