Provider Demographics
NPI:1700322252
Name:TRACY, ROCHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:TRACY
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 1:1457 W SOUTHERN AVE
Mailing Address - Street 2:STE 26
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4862
Mailing Address - Country:US
Mailing Address - Phone:480-374-7354
Mailing Address - Fax:
Practice Address - Street 1:1457 W. SOUTHERN AVE., SUITE 26
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4862
Practice Address - Country:US
Practice Address - Phone:480-374-7354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily