Provider Demographics
NPI:1972087732
Name:ROLLINS, TRACIE
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:ROLLINS
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 1:68 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03261-3232
Mailing Address - Country:US
Mailing Address - Phone:603-234-4790
Mailing Address - Fax:
Practice Address - Street 1:68 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:NH
Practice Address - Zip Code:03261-3232
Practice Address - Country:US
Practice Address - Phone:603-234-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH150187B9376K00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH73490IOtherSTATE OF NH