Provider Demographics
NPI:1760147748
Name:HOLMBERG, TRACY (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:HOLMBERG
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 1:8915 MUIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-6618
Mailing Address - Country:US
Mailing Address - Phone:678-699-3365
Mailing Address - Fax:
Practice Address - Street 1:8915 MUIRFIELD CT
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-6618
Practice Address - Country:US
Practice Address - Phone:678-699-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA202176163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse