Provider Demographics
NPI:1972262038
Name:DAVIS, TRACY (HEALTH EDUCATOR)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:HEALTH EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42515 N ACADIA WAY
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-2765
Mailing Address - Country:US
Mailing Address - Phone:651-470-2763
Mailing Address - Fax:
Practice Address - Street 1:42515 N ACADIA WAY
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-2765
Practice Address - Country:US
Practice Address - Phone:651-470-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator