Provider Demographics
NPI:1568701100
Name:WOODWARD, TRACIE MIXON (NP)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:MIXON
Last Name:WOODWARD
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 1:305 W BOBO NEWSOM HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550
Mailing Address - Country:US
Mailing Address - Phone:843-437-5456
Mailing Address - Fax:
Practice Address - Street 1:305 W BOBO NEWSOM HIGHWAY
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550
Practice Address - Country:US
Practice Address - Phone:843-309-3028
Practice Address - Fax:843-309-3029
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN173940363LF0000X
SC18982261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily