Provider Demographics
NPI:1760694772
Name:HOLLAND-HOLTER, TRACY ANN (APRN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:HOLLAND-HOLTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 RED FOX RD
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-9726
Mailing Address - Country:US
Mailing Address - Phone:406-273-6948
Mailing Address - Fax:
Practice Address - Street 1:9801 VALLEY GROVE DR APT D
Practice Address - Street 2:
Practice Address - City:LOLO
Practice Address - State:MT
Practice Address - Zip Code:59847-8617
Practice Address - Country:US
Practice Address - Phone:406-273-4633
Practice Address - Fax:406-273-4707
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN18497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily