Provider Demographics
NPI:1336852094
Name:LELLA, TRACI ANN (FNP)
Entity Type:Individual
Prefix:MS
First Name:TRACI
Middle Name:ANN
Last Name:LELLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:TRACI
Other - Middle Name:ANN
Other - Last Name:PITTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5257 W BOBWHITE WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-9371
Mailing Address - Country:US
Mailing Address - Phone:720-357-6243
Mailing Address - Fax:
Practice Address - Street 1:1714 W ANKLAM RD STE 104
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2690
Practice Address - Country:US
Practice Address - Phone:520-404-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350854363LF0000X
CA95017747363LF0000X
WI10956-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily