Healthcare Provider Details

I. General information

NPI: 1326251042
Provider Name (Legal Business Name): TRACY LYN HOLLAND LPN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 SAINT JOSEPH ST.
FREMONT OH
43420-4630
US

IV. Provider business mailing address

408 SAINT JOSEPH ST
FREMONT OH
43420-4630
US

V. Phone/Fax

Practice location:
  • Phone: 419-334-8466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberPN118417
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberPN118417
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberPN118417
License Number StateOH

VIII. Authorized Official

Name: MS. TRACY LYN HOLLAND
Title or Position: LPN
Credential:
Phone: 419-334-8466