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General NPI Number Information
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NPI Number | 1598688715
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HOLISTIC HEALING ADVANCED NURSING PC
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Dates
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Enumeration Date | 08/03/2026
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Last Update Date | 08/03/2026
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Provider Practice Location Address
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Address Line | 4600 S TRACY BLVD STE 107
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City | TRACY
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State | CA
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Zip | 95377-8105
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Country | US
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Telephone | 952-261-3330
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Fax |
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Provider Business Mailing Address
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Address Line | 6770 CELADON LN
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City | TRACY
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State | CA
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Zip | 95377-7705
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Country | US
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Telephone | 952-261-3330
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Fax |
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Authorized Official
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Title or Position | PMHNP-C
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Name | MAURINE B FORCHE
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Credential |
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Telephone | 952-261-3330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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