Provider Demographics
NPI:1710149000
Name:BOSTIC CLINGAN, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BOSTIC CLINGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1941
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570-1941
Mailing Address - Country:US
Mailing Address - Phone:205-921-7172
Mailing Address - Fax:
Practice Address - Street 1:620 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-4332
Practice Address - Country:US
Practice Address - Phone:205-495-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL93590068052279H0200X, 2279P1004X, 246W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health
No2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Diagnostics
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology