Provider Demographics
NPI:1932541505
Name:DAVIS, TRACY TAYLOR (PA-C)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:TAYLOR
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 CAROTHERS PKWY STE 301
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5917
Mailing Address - Country:US
Mailing Address - Phone:615-565-6670
Mailing Address - Fax:
Practice Address - Street 1:4323 CAROTHERS PKWY STE 301
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5917
Practice Address - Country:US
Practice Address - Phone:615-565-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107336363A00000X
TN3924363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHM522XOtherMEDICARE PTAN
FL009333400Medicaid
HM522ZMedicare PIN