Provider Demographics
NPI:1861623209
Name:NG, TRACY (DO)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 TAMIAMI TRL STE 1
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1018
Mailing Address - Country:US
Mailing Address - Phone:419-629-6262
Mailing Address - Fax:419-629-1782
Practice Address - Street 1:836 SUNSET LAKE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7555
Practice Address - Country:US
Practice Address - Phone:941-497-1771
Practice Address - Fax:941-492-9475
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13388207XX0005X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program