Provider Demographics
NPI:1467075549
Name:ERICKSON, TRACY EILEEN (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:EILEEN
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:332 POPE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-9467
Mailing Address - Country:US
Mailing Address - Phone:209-366-4814
Mailing Address - Fax:
Practice Address - Street 1:8950 CAL CENTER DR STE 160
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3225
Practice Address - Country:US
Practice Address - Phone:844-253-4537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95202847163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Single Specialty