Provider Demographics
NPI:1205901469
Name:FOX NELSON, TRACY N (PA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:N
Last Name:FOX NELSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:N
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 30532
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1532
Mailing Address - Country:US
Mailing Address - Phone:850-916-3700
Mailing Address - Fax:850-916-3710
Practice Address - Street 1:1040 GULF BREEZE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7809
Practice Address - Country:US
Practice Address - Phone:850-916-3700
Practice Address - Fax:850-916-3710
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102098363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCL2119OtherMEDICARE RAILROAD
AL59193887OtherBCBS ALABAMA - GBO
FLY01C8OtherBLUE CROSS BLUE SHIELD
AL115029Medicaid
FLP00397348OtherMEDICARE RAILROAD
FL000215800Medicaid
AL592-09448OtherBLUE CROSS BLUE SHIELD
AL59197534OtherBCBS ALABAMA
9147144OtherAETNA PIN
P00869427OtherMEDICARE RAILROAD
FL000215800Medicaid
FLAD230ZMedicare UPIN
FL5789020004Medicare NSC
FLY01C8OtherBLUE CROSS BLUE SHIELD