Provider Demographics
NPI:1730524844
Name:COUSE, TRACEY (FNP-C)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:COUSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105E HAMMOND DRIVE
Mailing Address - Street 2:SUITE 400, 600, 650
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5334
Mailing Address - Country:US
Mailing Address - Phone:404-256-2633
Mailing Address - Fax:404-256-6532
Practice Address - Street 1:1105E HAMMOND DRIVE
Practice Address - Street 2:SUITE 400, 600, 650
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5334
Practice Address - Country:US
Practice Address - Phone:404-256-2633
Practice Address - Fax:404-256-6532
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191714163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice