Provider Demographics
NPI:1538382429
Name:MANYARA, TRACY L (FNP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:L
Last Name:MANYARA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:L
Other - Last Name:SCHIAVETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:6315 COLEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227
Mailing Address - Country:US
Mailing Address - Phone:804-261-0569
Mailing Address - Fax:
Practice Address - Street 1:VIRIGNIA COMMONWEALTH UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:1250 EAST MARSHALL STREET
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0401
Practice Address - Country:US
Practice Address - Phone:804-628-1932
Practice Address - Fax:804-628-7474
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024156421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily