Provider Demographics
NPI:1891266730
Name:TRCKA, DAVID SCOTT (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:TRCKA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 NICKLAUS DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3766
Mailing Address - Country:US
Mailing Address - Phone:507-259-2555
Mailing Address - Fax:
Practice Address - Street 1:916 ST. PETER AVE E
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-2813
Practice Address - Country:US
Practice Address - Phone:952-442-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12867363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant