Provider Demographics
NPI:1386312445
Name:COOPER, TRACEY LYNN (FNP-BC)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 W CHANDLER BLVD STE B10
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5204
Mailing Address - Country:US
Mailing Address - Phone:480-385-5055
Mailing Address - Fax:
Practice Address - Street 1:19724 E EMPEROR BLVD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-8732
Practice Address - Country:US
Practice Address - Phone:520-349-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ263470207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine