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TRACY R ENNIS — Medicare Enrolled Provider (PRACTITIONER - PHYSICIAN ASSISTANT, FL)

TRACY R ENNIS — Medicare Enrolled Provider (PRACTITIONER - PHYSICIAN ASSISTANT, FL) is one of 9,000 enrolled providers in the MedicareEnroll dataset. Key details — Name: TRACY R ENNIS; Type: Individual; NPI: 1003121609.

NameTRACY R ENNIS
TypeIndividual
NPI1003121609
Provider typePRACTITIONER - PHYSICIAN ASSISTANT
StateFL
Enrollment IDI20160519001473
Multiple NPI flagN
SourceCMS Medicare FFS Public Provider Enrollment (PECOS)

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