Healthcare Provider Details

I. General information

NPI: 1144707373
Provider Name (Legal Business Name): TRACI SICKICH FNP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 3215 BOX 86TH
APO AE
09094-3215
US

IV. Provider business mailing address

UNIT 3215 BOX 86TH
APO AE
09094-3215
US

V. Phone/Fax

Practice location:
  • Phone: -479-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number135536
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number135536
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: