Provider Demographics
NPI:1568129302
Name:SWAFFORD, TRACIE ANN (PA)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:ANN
Last Name:SWAFFORD
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:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 AVOCADO AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7798
Practice Address - Country:US
Practice Address - Phone:949-763-2204
Practice Address - Fax:949-536-8036
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-28
Last Update Date:2023-11-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant