Provider Demographics
NPI:1932541505
Name:TAYLOR, TRACY SAMANTHA (PA-C)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:SAMANTHA
Last Name:TAYLOR
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 1:4230 HARDING PIKE
Mailing Address - Street 2:STE 530
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2094
Mailing Address - Country:US
Mailing Address - Phone:615-222-5500
Mailing Address - Fax:615-222-5601
Practice Address - Street 1:3000 E FLETCHER AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4656
Practice Address - Country:US
Practice Address - Phone:813-910-0027
Practice Address - Fax:813-971-1286
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3924363A00000X
FLPA9107336363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHM522XOtherMEDICARE PTAN
FL009333400Medicaid
HM522ZMedicare PIN