Provider Demographics
NPI:1972257558
Name:LE, TRACY (PA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:PA
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Other - Middle Name:
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Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:352-567-0188
Mailing Address - Fax:813-355-5101
Practice Address - Street 1:3665 MADACA LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2048
Practice Address - Country:US
Practice Address - Phone:813-280-7380
Practice Address - Fax:813-355-5899
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9115362363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant