Provider Demographics
NPI:1710900840
Name:STEVENSON, TRACY L (PA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7400 S POWER RD
Mailing Address - Street 2:BLDG 5, STE 120
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-9281
Mailing Address - Country:US
Mailing Address - Phone:480-988-1659
Mailing Address - Fax:480-988-1871
Practice Address - Street 1:7400 S POWER RD
Practice Address - Street 2:BLDG 5, STE 120
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-9281
Practice Address - Country:US
Practice Address - Phone:480-988-1659
Practice Address - Fax:480-988-1871
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-08-05
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP55660Medicare UPIN
AZZ69416Medicare PIN