Provider Demographics
NPI:1962839696
Name:WOOD, TRACEY CHRISTINE (PNP-PC)
Entity Type:Individual
Prefix:MISS
First Name:TRACEY
Middle Name:CHRISTINE
Last Name:WOOD
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 OLD KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6353
Mailing Address - Country:US
Mailing Address - Phone:717-421-4512
Mailing Address - Fax:843-652-3200
Practice Address - Street 1:140 BANDAGE CT
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5103
Practice Address - Country:US
Practice Address - Phone:843-652-3300
Practice Address - Fax:843-652-3200
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN.18497 APRN363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics