Provider Demographics
NPI:1336379106
Name:WATSON, TRACY CAROLE (ACSM-CEP, PA-C)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:CAROLE
Last Name:WATSON
Suffix:
Gender:F
Credentials:ACSM-CEP, PA-C
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:CAROLE WATSON
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:MAIN HOSPITAL N 1181
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:919-966-5165
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:MAIN HOSPITAL N 1181
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:919-966-5165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Y00000X
NC0010-01893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10-01893OtherNC MEDICAL BOARD LICENSE
580613OtherAMERICAN COLLEGE OF SPORTS MEDICINE