Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 19933 | TN |
NPI | 1033595111 |
---|---|
Provider Name | Tracy Alison Robertson |
First Address | Chattanooga, TN 37421-3125 |
Second Address | Chattanooga, TN 37421-1984 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2015 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19933 | APN LICENSE (01) | TN |