Tracy R. Ennis, PA-C

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

PA9108883 Issued in FL

Practice address

2235 Venetian Court
Suite 1
Naples, FL 34109-8728

Phone

(239) 596-9337

Fax

(239) 596-9466

NPI assigned

Aug 9, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Woodruff Institute LLCGroup PAC ID 1658351101, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: tennispa@woodruff.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Woodruff Institute LLC

  • Dermatology Physician
  • Naples, FL
  • NPI 1558371195
  Medicare reassignment Care Compare group
• Lisa D Zack MD PA

  • Dermatology Physician
  • Naples, FL
  • NPI 1518189927
  Medicare reassignment
• Florida Coastal Surgery Center, Inc

  • Ambulatory Surgical Clinic/Center
  • Naples, FL
  • NPI 1003812686
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682294400000",
    "number": "1003121609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2235 VENETIAN COURT",
            "address_2": "SUITE 1",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341098728",
            "telephone_number": "239-596-9337",
            "fax_number": "239-596-9466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 VENETIAN COURT",
            "address_2": "SUITE 1",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341098728",
            "telephone_number": "239-596-9337",
            "fax_number": "239-596-9466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "TRACY",
        "middle_name": "R.",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-09",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA 06798",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9108883",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "PA9108883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "WYB4U",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017347700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John T English, MD
• Krissy N English, DNP, PMHNP-BC, FNP-C
• Margo M English, MSW, LCSW
• Yovanni Jacqueline Enmanuel-Tineo, DO
• Simone Ennevor
• Lauren Enos, M.S., CCC-SLP
• Yaimary Beatriz Enriquez Rivera
• Cristy Ensenat, LMHC
• Jason Ensor, APRN
• Epiphany Salon & Spa

• Dermatology Physician in Naples, FL
• Providers in Naples, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.