Provider Demographics
NPI:1750468138
Name:ALDRIDGE, TRACI RAE (WHNP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:RAE
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:INNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11209 N. TATUM BLVD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028
Mailing Address - Country:US
Mailing Address - Phone:602-494-5050
Mailing Address - Fax:602-889-9140
Practice Address - Street 1:11209 N. TATUM BLVD
Practice Address - Street 2:SUITE 255
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028
Practice Address - Country:US
Practice Address - Phone:602-494-5050
Practice Address - Fax:602-889-9140
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP2549363LW0102X
AZAP2549363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZTAP2549OtherONE YEAR WHNP LICENSURE