Provider Demographics
NPI:1457087413
Name:BROOKS, TRACY A (LPN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-8913
Mailing Address - Country:US
Mailing Address - Phone:706-781-6987
Mailing Address - Fax:706-781-3026
Practice Address - Street 1:20 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-8913
Practice Address - Country:US
Practice Address - Phone:706-781-6987
Practice Address - Fax:706-781-3026
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN038645164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse