Provider Demographics
NPI:1285104216
Name:TARTAGLIONE, TRACY (PA-C)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:TARTAGLIONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:MICHNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 75868
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-5868
Mailing Address - Country:US
Mailing Address - Phone:703-383-6469
Mailing Address - Fax:
Practice Address - Street 1:13350 FRANKLIN FARM RD STE 220
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4095
Practice Address - Country:US
Practice Address - Phone:703-810-5204
Practice Address - Fax:703-810-5411
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant