Individual
TRACEY AMANDA BLEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2021 KINGSLEY AVE, SUITE 101, ORANGE PARK, FL 32073-5174
(904) 298-2113
(904) 298-2113
Mailing address
2021 KINGSLEY AVE, SUITE 101, ORANGE PARK, FL 32073-5174
(904) 298-2113
(904) 298-2113
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 910322
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
258902800
—
FL
Enumeration date
10/04/2006
Last updated
07/20/2010
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