Provider Demographics
NPI:1942855705
Name:VOPALENSKY, TRACI ANN (FNP)
Entity Type:Individual
Prefix:
First Name:TRACI ANN
Middle Name:
Last Name:VOPALENSKY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 N SCOTTSDALE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7652
Mailing Address - Country:US
Mailing Address - Phone:480-874-5806
Mailing Address - Fax:480-210-8194
Practice Address - Street 1:4900 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7652
Practice Address - Country:US
Practice Address - Phone:480-874-5806
Practice Address - Fax:480-210-8194
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP221855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP221855OtherSTATE OF ARIZONA