Tracey Ann Miller Warren, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9103831 Issued in FL

Practice address

1505 Delaware Ave
Fort Pierce, FL 34950-3975

Phone

(772) 461-1402

Fax

(561) 847-2306

NPI assigned

Aug 14, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tracey Ann Patrice Miller Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459123200000",
    "number": "1336152172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4450 S TIFFANY DR",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334073241",
            "telephone_number": "561-844-9443",
            "fax_number": "561-844-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 DELAWARE AVE",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349503975",
            "telephone_number": "772-461-1402",
            "fax_number": "561-847-2306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "TRACEY ANN",
        "middle_name": "MILLER",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2016-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9103831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292578800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACEY ANN",
            "last_name": "MILLER",
            "middle_name": "PATRICE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Garth Walters, M.D.
• Bo Wang, M.D.
• Mariam Wanis
• Tabitha Ward
• Cherail Winett Ware-Stark, LPN
• Tanovia L. Washington
• Judith Barbara Waska, RN
• Julia Ann Watkins
• Lisa Brook Watts, MSW
• Jennifer A Way

• Medical Physician Assistant in Fort Pierce, FL
• Providers in Fort Pierce, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.