Provider Demographics
NPI:1154753317
Name:CRONE, TRACIE M (PA-C)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:M
Last Name:CRONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:M
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34844 PICNIC BASKET CT
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4424
Mailing Address - Country:US
Mailing Address - Phone:302-644-1300
Mailing Address - Fax:302-644-1086
Practice Address - Street 1:34435 KING STREET ROW
Practice Address - Street 2:SUITE 1
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4787
Practice Address - Country:US
Practice Address - Phone:302-644-1300
Practice Address - Fax:302-644-1086
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056271363AM0700X
DEC5-0001041363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC5-0001041OtherMEDICAL LICENSE