Provider Demographics
NPI:1558709394
Name:POLLARD-JOHNSON, TRACY ANGELIA
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ANGELIA
Last Name:POLLARD-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ANGELIA
Other - Last Name:POLLARD-JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:4360 MONTEBELLO DR
Mailing Address - Street 2:SUITE 900
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7204
Mailing Address - Country:US
Mailing Address - Phone:719-388-1594
Mailing Address - Fax:
Practice Address - Street 1:8540 SCARBOROUGH DR
Practice Address - Street 2:SUITE 370
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7502
Practice Address - Country:US
Practice Address - Phone:719-358-8270
Practice Address - Fax:719-358-8299
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990531-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily