Provider Demographics
NPI:1487198966
Name:GUILFOY, TRACEY L (NP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:GUILFOY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 LINDEN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6902
Mailing Address - Country:US
Mailing Address - Phone:540-504-0075
Mailing Address - Fax:540-678-9025
Practice Address - Street 1:212 LINDEN DR
Practice Address - Street 2:SUITE 152
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2894
Practice Address - Country:US
Practice Address - Phone:540-667-0744
Practice Address - Fax:540-685-0385
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487198966Medicaid
VAVVN794B566Medicare PIN