Provider Demographics
NPI:1326043225
Name:SEEL, TRACY ANN (PA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:SEEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:288 S PARADISE PARKWAY
Mailing Address - Street 2:P.O. BOX 154
Mailing Address - City:GARDEN CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84028
Mailing Address - Country:US
Mailing Address - Phone:435-255-1630
Mailing Address - Fax:435-946-9124
Practice Address - Street 1:288 S PARADISE PARKWAY
Practice Address - Street 2:P.O. BOX 154
Practice Address - City:GARDEN CITY
Practice Address - State:UT
Practice Address - Zip Code:84028
Practice Address - Country:US
Practice Address - Phone:435-255-1630
Practice Address - Fax:435-946-9124
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4842080-1206363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY308604OtherBCBS
WY970018032Medicare PIN
WYW308604Medicare PIN
WYP17281Medicare UPIN