Provider Demographics
NPI:1932149838
Name:THOMAS, TRACY JO (NP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:JO
Last Name:THOMAS
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Gender:F
Credentials:NP
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Mailing Address - Street 1:3800 WOODWARD AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2061
Mailing Address - Country:US
Mailing Address - Phone:313-262-1309
Mailing Address - Fax:313-262-1238
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:SUITE 4C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-4755
Practice Address - Fax:313-993-0085
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-07-19
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Provider Licenses
StateLicense IDTaxonomies
MI4704169739363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health