Bleau, Tracey Amanda

Bleau, Tracey Amanda is an individual health care provider with primary practice located at 2021 Kingsley Ave Suite 101, Orange Park FL 32073-5174. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Bleau, Tracey Amanda can be contacted via phone (904) 298-2113.

Contact Information

Primary practice address
2021 Kingsley Ave Suite 101 Orange Park FL 32073-5174
Phone: (904) 298-2113
Fax: (904) 298-2113
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA 910322 Florida

Profile Details

NPI number 1215023775
LBN Legal business name Bleau, Tracey Amanda
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 4th, 2006
Last updated Jul 20th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215023775 NPPES
Florida MEDICAID 258902800

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