Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | ME149172 | FL |
NPI | 1033572870 |
---|---|
Provider Name | Tracy Tholanikunnel |
First Address | Gainesville, FL 32607-4144 |
Second Address | Gainesville, FL 32610-3003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 24/06/2021 |