Provider Demographics
NPI:1568588960
Name:TATUM, TRACEY D (NP)
Entity Type:Individual
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First Name:TRACEY
Middle Name:D
Last Name:TATUM
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Gender:F
Credentials:NP
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Mailing Address - Street 1:1051 JOHNSTON WILLIS DR
Mailing Address - Street 2:STE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4871
Mailing Address - Country:US
Mailing Address - Phone:804-320-2751
Mailing Address - Fax:804-673-9218
Practice Address - Street 1:7101 JAHNKE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4017
Practice Address - Country:US
Practice Address - Phone:804-320-2751
Practice Address - Fax:804-673-9218
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2016-01-19
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Provider Licenses
StateLicense IDTaxonomies
VA0024164843363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP34981Medicare UPIN