Provider Demographics
NPI:1831429257
Name:TOFT, TRACY (PA-C)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:TOFT
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 1:5300 N. INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2136
Mailing Address - Country:US
Mailing Address - Phone:405-364-0555
Mailing Address - Fax:405-573-5464
Practice Address - Street 1:700 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6232
Practice Address - Country:US
Practice Address - Phone:405-364-0555
Practice Address - Fax:405-573-5464
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1892363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280845301Medicaid
TXP00949096OtherPALMETTO RR
TXTXB151005Medicare PIN
TXTXB128131Medicare PIN
TX280845301Medicaid
TXTXB130344Medicare PIN