MS. TRACY A. FENN (NPI# 1750318242) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750318242 |
| Entity Type | Individual |
| Full Name | MS. TRACY A. FENN |
| Credential | PA-C |
| Practice Address |
Lumar Plaza, 1847 Psl Blvd Wellmed Medical Managment of Florida, Inc. Port St. Lucie FL 94952 |
| Mailing Address |
80 Greta Ln Henderson NC 27537-3475 |
| Practice Telephone | 7725792303 |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2008-01-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
NC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
LUMAR PLAZA, 1847 PSL BLVD WELLMED MEDICAL MANAGMENT OF FLORIDA, INC. |
| City | PORT ST. LUCIE |
| State | FL |
| Zip Code | 94952 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114587680 | Benjamin R Idarius | Behavior Technician | 101 H St. Ste. L, Petaluma, CA 94952 | 2019-06-17 |
| 1518457159 | Kyleen Joan Romero | Behavioral Analyst | 25 Graylawn Ave, Petaluma, CA 94952 | 2018-05-17 |
| 1437647526 | John Scruggs | Behavior Technician | 301 H St. Suit L, Petaluma, CA 94952 | 2018-04-25 |
| 1811404684 | Brief and Strategic Counseling Service | Counselor | 843 Chardonnay Cir., Petaluma, CA 94952 | 2018-01-03 |
| 1730638396 | Jennifer Lee Sloan | Acupuncturist | 517 Hayes Lane, Petaluma, CA 94952 | 2016-09-23 |
| 1982057295 | Elene Hwa-yihg Chung | Acupuncturist | 130 Graylawn Ave.,#f, Petaluma, CA 94952 | 2016-07-21 |
| 1457773624 | Lisa Hirsch Cordeiro | Marriage & Family Therapist | 700 Sixth Street, Petaluma, CA 94952 | 2014-01-07 |
| 1811271075 | Jacques Philippe Archer | Massage Therapist | 131b Kentucky St., Petaluma, CA 94952 | 2011-10-06 |
| 1477841609 | Karna Licia Dawson | Social Worker | 205 Keller St., Petaluma, CA 94952 | 2011-07-21 |
| 1497051783 | Melissa Beth Wilson | Acupuncturist | 155a Kentucky Street, Petaluma, CA 94952 | 2011-02-03 |
| Find all providers in zip 94952 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922396761 | Stuart B. Krost M.d.p.a. | Physician Assistant | 1903 S.e. Port St. Lucie Blvd, Port St. Lucie, FL 34952 | 2011-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255931325 | Jonathan Thomas Nusbaum | Physician Assistant | 26160 Angelica Rd, Punta Gorda, FL 33955-1419 | 2020-10-28 |
| 1235738659 | Kevin Marcus Luks | Physician Assistant | 10701 Santa Fe Dr, Hollywood, FL 33026-4955 | 2020-10-19 |
| 1245839521 | Stephanie Clay | Physician Assistant | 3455 Rose Mallow Loop, Oviedo, FL 32766-6648 | 2020-10-19 |
| 1104423755 | Lou Joseph Schneggenburger | Physician Assistant | 10115 Forest Hill Blvd Ste 100, Wellington, FL 33414-6178 | 2020-10-07 |
| 1235744582 | Stephanie Graham | Physician Assistant | 1053 Bernice Rd, Rockledge, FL 32955-2201 | 2020-09-14 |
| 1790399483 | Shyla Imani Kissoon | Physician Assistant | 4830 Nw 7th St, Plantation, FL 33317-1410 | 2020-09-01 |
| 1770193500 | My Physician Online | Physician Assistant | 9540 Nw 23rd St, Coral Springs, FL 33065-4974 | 2020-08-06 |
| 1225647977 | Robert Drew Singleton | Physician Assistant | 17501 Biscayne Blvd Ste 460, Aventura, FL 33160-4806 | 2020-07-29 |
| 1750990974 | Andrea K Webber | Physician Assistant | 8119 Sw State Rd 200, Ocala, FL 34481-3448 | 2020-07-23 |
| 1851919526 | Kyra Panni | Physician Assistant | 3857 Hartwood Ln, Jacksonville, FL 32216-1486 | 2020-07-09 |
| Find all providers with the same taxonomy | ||||
| City | PORT ST. LUCIE |
| Zip Code | 94952 |
Please comment or provide details below to improve the information on MS. TRACY A. FENN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.