Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tracy L Wickware, PA

Individual provider Physician Assistant · NPI 1417025636

Tracy L Wickware, PA is a Physician Assistant in San Diego, California. Qualified in 2004, 22 years ago. Practices with Neighborhood Healthcare, a 152-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
22
Licensed in
CA
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

3930 4th Ave Ste 200
San Diego, CA 92103-3119
Phone: (619) 297-9610
Fax: (619) 297-2244
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA17814 (CA)

Record details

NPI number1417025636
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedDecember 4, 2006
Last updated in NPPESMarch 7, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Neighborhood Healthcare — 152 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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