Provider Demographics
NPI:1861080418
Name:TORGERSON, TRACY J (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:J
Last Name:TORGERSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:JOHANNA
Other - Last Name:COSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITONER
Mailing Address - Street 1:531 ROSELANE ST NW STE 710
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6975
Mailing Address - Country:US
Mailing Address - Phone:678-331-3297
Mailing Address - Fax:678-581-7187
Practice Address - Street 1:340 KENNESTONE HOSPITAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1158
Practice Address - Country:US
Practice Address - Phone:770-281-5100
Practice Address - Fax:678-581-7100
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN137388363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1861080418OtherNPI NUMBER