Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 165081 | GA |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 201683 | NC |
N | 363LP2300X | Nurse Practitioner - Primary Care | 201683 | NC |
NPI | 1043204969 |
---|---|
Provider Name | Tracy Andrea Carstarphen |
First Address | Lawrenceville, GA 30043-1325 |
Second Address | Atlanta, GA 30342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 22/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2631996 | UNITED HEALTHCARE (01) | |
6005024 | (05) | NC |
P94159 | (02) |