Provider Demographics
NPI:1497398820
Name:TOOMER, RACQUEL (RN)
Entity Type:Individual
Prefix:
First Name:RACQUEL
Middle Name:
Last Name:TOOMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806 WOOD HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-6080
Mailing Address - Country:US
Mailing Address - Phone:470-902-8400
Mailing Address - Fax:
Practice Address - Street 1:3806 WOOD HOLLOW WAY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6080
Practice Address - Country:US
Practice Address - Phone:470-902-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2023-02-13
Deactivation Date:2021-12-05
Deactivation Code:
Reactivation Date:2023-02-07
Provider Licenses
StateLicense IDTaxonomies
GARN190526163WP0808X, 163WP0200X, 363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN190526OtherRN LICENSE NUMBER