Provider Demographics
NPI:1407825235
Name:ARNEY, TRACI D (NP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:D
Last Name:ARNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:MCDERMOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C, AE-C
Mailing Address - Street 1:PO BOX 9362
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9362
Mailing Address - Country:US
Mailing Address - Phone:480-892-2260
Mailing Address - Fax:480-892-2274
Practice Address - Street 1:4001 E BASELINE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2726
Practice Address - Country:US
Practice Address - Phone:480-892-2260
Practice Address - Fax:480-892-2274
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1811363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ943010Medicaid
Q44983Medicare UPIN
AZ103364Medicare PIN