Provider Demographics
NPI:1801819222
Name:SEAVER, TRACEY (PA)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:
Last Name:SEAVER
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:PO BOX 29870
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9870
Mailing Address - Country:US
Mailing Address - Phone:602-772-3800
Mailing Address - Fax:602-772-3801
Practice Address - Street 1:20325 N 51ST AVE
Practice Address - Street 2:BLDG 4, STE 124
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5674
Practice Address - Country:US
Practice Address - Phone:602-795-6300
Practice Address - Fax:623-414-3311
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3115363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant