Individual
MS. TRACY R. ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2235 VENETIAN COURT, SUITE 1, NAPLES, FL 34109-8728
(239) 596-9337
(239) 596-9466
Mailing address
2235 VENETIAN COURT, SUITE 1, NAPLES, FL 34109-8728
(239) 596-9337
(239) 596-9466
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
PA9108883
FL
363A00000X
Physician Assistant
PA 06798
TX
363A00000X
Physician Assistant
PA9108883
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017347700
—
FL
01
—
WYB4U
BCBS
FL
Enumeration date
08/09/2010
Last updated
04/24/2023
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