Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | PTA23153 | FL |
N | 213ES0000X | Sports Medicine | PTA23153 | FL |
NPI | 1275665283 |
---|---|
Provider Name | Tracy Nicole Wilcox |
First Address | Jacksonville, FL 32258-1718 |
Second Address | Jacksonville, FL 32258-1718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 20/06/2018 |