Provider Demographics
NPI:1700935723
Name:NIMEH, TRACEY LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:NIMEH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:LYNN
Other - Last Name:STECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
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:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:602 S HOWARD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2413
Practice Address - Country:US
Practice Address - Phone:813-253-2406
Practice Address - Fax:813-257-4290
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103963363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01600606OtherRR MCR
FL003142600Medicaid
FL003142600Medicaid
FLAG170X - HILLSBOROUGMedicare PIN