Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 0024172774 | VA |
NPI | 1053796607 |
---|---|
Provider Name | Tracy Thomas Germaine |
First Address | Fredericksburg, VA 22408-7760 |
Second Address | Fredericksburg, VA 22408-7760 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2015 |
Last Update Date | 24/07/2015 |