Healthcare Provider Details

I. General information

NPI: 1306277751
Provider Name (Legal Business Name): TRACY J BORDERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 RUTLAND DR NW
AIKEN SC
29801-4013
US

IV. Provider business mailing address

449 RUTLAND DR NW
AIKEN SC
29801-4013
US

V. Phone/Fax

Practice location:
  • Phone: 803-641-2500
  • Fax: 803-641-2502
Mailing address:
  • Phone: 803-641-2500
  • Fax: 803-641-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number39761
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: