Individual
TRACY A EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2138 MENDON RD, SUITE 302, CUMBERLAND, RI 02864-3834
(401) 334-1060
(401) 334-1063
Mailing address
725 RESERVOIR AVE, SUITE 101, CRANSTON, RI 02910-4448
(401) 944-3800
(401) 944-1342
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
CPA00245
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922094853
DURABLE
RI
01
—
2036
BC
RI
01
—
408249
BLUE CHIP
RI
05
—
7008740
—
RI
Enumeration date
09/26/2005
Last updated
05/16/2016
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