Provider Demographics
NPI:1366422396
Name:MCMONIGLE, TRACY LEE (PA-C /MPAS)
Entity type:Individual
Prefix:MR
First Name:TRACY
Middle Name:LEE
Last Name:MCMONIGLE
Suffix:
Gender:M
Credentials:PA-C /MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US NAVAL HOSPITAL GUAM
Mailing Address - Street 2:FARENHOLT AVE BLDG K-1
Mailing Address - City:AGANA HTS
Mailing Address - State:GU
Mailing Address - Zip Code:96919
Mailing Address - Country:US
Mailing Address - Phone:671-344-9619
Mailing Address - Fax:
Practice Address - Street 1:US NAVAL HOSPITAL GUAM
Practice Address - Street 2:FARENHOLT AVE BLDG K-1
Practice Address - City:AGANA HTS
Practice Address - State:GU
Practice Address - Zip Code:96919
Practice Address - Country:US
Practice Address - Phone:671-344-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105808363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant