Individual
TRACY LYNN LEONARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1300 SENTARA PARK # 3, VIRGINIA BEACH, VA 23464-5884
(757) 252-3050
Mailing address
1300 SENTARA PARK # 3, VIRGINIA BEACH, VA 23464-5884
(757) 252-3050
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002438
VA
363AM0700X
Medical Physician Assistant
0110002438
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110002438
STATE LICENSE
VA
01
—
541398620
ORGANIZATION TAX ID
VA
01
—
541870680
ORGANIZATOIN TAX ID
VA
Enumeration date
02/19/2007
Last updated
04/17/2024
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