Provider Demographics
NPI:1457421182
Name:HOEY, TRACY LEE (PA-C)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LEE
Last Name:HOEY
Suffix:
Gender:F
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:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:303-338-4545
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:5985 SILVER FALLS RUN STE 100
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-1291
Practice Address - Country:US
Practice Address - Phone:941-202-2055
Practice Address - Fax:888-571-5463
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1839363AM0700X
FLPA9119134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO024572OtherKAISER COMMERCIAL NUMBER
CO18225063Medicaid
CO354722YK5YMedicare PIN