Provider Demographics
NPI:1548491707
Name:TONSOR, TRACEY LEE (PA-C, MPAS)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LEE
Last Name:TONSOR
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:MISS
Other - First Name:TRACEY
Other - Middle Name:TONSOR
Other - Last Name:BROWNBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPAS
Mailing Address - Street 1:158 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4100
Mailing Address - Country:US
Mailing Address - Phone:434-791-1088
Mailing Address - Fax:434-799-8525
Practice Address - Street 1:158 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4100
Practice Address - Country:US
Practice Address - Phone:434-791-1088
Practice Address - Fax:434-799-8525
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003020363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant