| Doctor Name: | TRACY A. PENN |
| NPI Number: | 1083657480 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A.-C |
| License Number: | PA04795 |
| Business Practice Address: | 2010 Nine Road Rehab. Center Frontera Healthcare Network, Inc. Brady, TX - 76825 |
| Business Phone Number: | 3255970102 |
| Business Fax Number: | 3255972939 |
| Mailing Address: | P.o. Box 989, 604 Eaker St. Frontera Healthcare Network, Inc. EDEN |
| State: | TX |
| Postal Code: | 76837 |
| Phone Number: | 3258695500 |
| Fax Number: | 3258695692 |
| NPI Enumeration Date: | 06/14/2006 |
| NPI Last Update Date: | 05/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA04795 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |