Provider Demographics
NPI:1053018705
Name:CALHOUN, TRACY (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BUCKINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35904-3131
Mailing Address - Country:US
Mailing Address - Phone:256-295-0057
Mailing Address - Fax:
Practice Address - Street 1:104 BUCKINGHAM PL
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35904-3131
Practice Address - Country:US
Practice Address - Phone:256-295-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-118084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-118084OtherBOARD OF NURSING
2022139838OtherANCC