Individual
ANN M TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.P.R.N
Contact information
Practice address
3255 S RURAL RD, TEMPE, AZ 85282
(480) 304-5467
Mailing address
615 E WEBER DR #1027, TEMPE, AZ 85281
(316) 708-8155
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
45469
KS
363LF0000X
Family Nurse Practitioner
Primary
AP9582
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000016406
BC/BS PROVIDER NUMBER
KS
Enumeration date
06/13/2005
Last updated
11/07/2016
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