Healthcare Provider Details

I. General information

NPI: 1558709394
Provider Name (Legal Business Name): MS. TRACY ANGELIA POLLARD-JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY ANGELIA POLLARD-JOHNSON APN

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SHOAL CREEK BLVD STE 118W
AUSTIN TX
78757-1007
US

IV. Provider business mailing address

4360 MONTEBELLO DR SUITE 900
COLORADO SPRINGS CO
80918-7204
US

V. Phone/Fax

Practice location:
  • Phone: 512-407-8880
  • Fax: 512-407-8681
Mailing address:
  • Phone: 719-388-1594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0990531-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: