Provider Demographics
NPI:1275974081
Name:SCHILLER, TRACY E (PA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:E
Last Name:SCHILLER
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 1:3618 LANTANA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2246
Mailing Address - Country:US
Mailing Address - Phone:561-296-1188
Mailing Address - Fax:
Practice Address - Street 1:3618 LANTANA RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-2246
Practice Address - Country:US
Practice Address - Phone:561-296-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106935363AM0700X
IA002388363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical