Provider Demographics
NPI:1396134284
Name:WOFFORD, TRACY SHANOHA LAVETTE (NP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:SHANOHA LAVETTE
Last Name:WOFFORD
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 1:10174 FLORIDA CIR N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2767
Mailing Address - Country:US
Mailing Address - Phone:612-803-9344
Mailing Address - Fax:
Practice Address - Street 1:10174 FLORIDA CIR N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2767
Practice Address - Country:US
Practice Address - Phone:612-803-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR175874-6363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily