Provider Demographics
NPI:1366576423
Name:TRAPANESE, TRACEE A (PA-C, MPH)
Entity type:Individual
Prefix:
First Name:TRACEE
Middle Name:A
Last Name:TRAPANESE
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:TRACEE
Other - Middle Name:A
Other - Last Name:TRAPANESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C, MPH
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:350 NW 84TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1859
Practice Address - Country:US
Practice Address - Phone:954-474-2929
Practice Address - Fax:954-474-9708
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102125174400000X
FLPA 9102125363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3828981OtherCIGNA
FLP1004316OtherFREEDOM HEALTH
FLY0CR7OtherBCBS FL
FL9607901OtherAETNA
FLP944411OtherOPTIMUM
FL26229OtherMEDICA
FL363942OtherAVMED
FLP01130777OtherRAILROAD MCR
FLPA9102125OtherMEDICAL LICENSE
FL1249039OtherWELLCARE
FL1249039OtherWELLCARE