Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 307097 | CA |
N | 363LC1500X | Nurse Practitioner - Community Health | 307097 | CA |
N | 363LG0600X | Nurse Practitioner - Gerontology | 307097 | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 307097 | CA |
N | 363LS0200X | School | 307097 | CA |
N | 363LX0106X | Nurse Practitioner - Occupational Health | 307097 | CA |
NPI | 1326203373 |
---|---|
Provider Name | Ms. Tracy Georgis |
First Address | Palos Verdes Estates, CA 90274 |
Second Address | Palos Verdes Estates, CA 90274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2008 |
Last Update Date | 18/07/2008 |