Individual
TRACEY LYNN WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5005 RUSTON WAY, STE 125, TACOMA, WA 98402-5314
(253) 759-4522
(253) 759-4699
Mailing address
5005 RUSTON WAY, STE 125, TACOMA, WA 98402-5314
(253) 759-4522
(253) 759-4699
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
60413586
WA
363AM0700X
Medical Physician Assistant
PA9102446
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2916622000
—
FL
01
—
336140
STATE L&I
WA
Enumeration date
11/05/2005
Last updated
02/20/2015
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