Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 185022 | GA |
NPI | 1003095977 |
---|---|
Provider Name | Tracy Purcell Nicholas |
First Address | Atlanta, GA 30309-1281 |
Second Address | Atlanta, GA 30309-1281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2007 |
Last Update Date | 29/10/2007 |