Healthcare Provider Details

I. General information

NPI: 1760694772
Provider Name (Legal Business Name): TRACY ANN HOLLAND-HOLTER A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 VALLEY GROVE DR APT D
LOLO MT
59847-8617
US

IV. Provider business mailing address

244 RED FOX RD
LOLO MT
59847-9726
US

V. Phone/Fax

Practice location:
  • Phone: 406-273-4633
  • Fax: 406-273-4707
Mailing address:
  • Phone: 406-273-6948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN18497
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: