Provider Demographics
NPI:1801801733
Name:PINKSTON, TRACEY ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:ELIZABETH
Last Name:PINKSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:ELIZABETH
Other - Last Name:JONES PINKSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4300 BAYOU BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1949
Mailing Address - Country:US
Mailing Address - Phone:850-473-1008
Mailing Address - Fax:850-473-1009
Practice Address - Street 1:4300 BAYOU BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-1949
Practice Address - Country:US
Practice Address - Phone:850-473-1008
Practice Address - Fax:850-473-1009
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56044OtherBLUE SHIELD OF FL
G24338Medicare UPIN