Healthcare Provider Details

I. General information

NPI: 1699726869
Provider Name (Legal Business Name): TRACY L HOULE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY L. HOLT APRN

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 KEEGAN RD
PLYMOUTH CT
06782-2608
US

IV. Provider business mailing address

12 ROLLING RIDGE CT
PROSPECT CT
06712-1737
US

V. Phone/Fax

Practice location:
  • Phone: 860-340-8280
  • Fax: 860-283-9851
Mailing address:
  • Phone: 203-758-0836
  • Fax: 203-758-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number002671
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2671
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: