Healthcare Provider Details

I. General information

NPI: 1386312445
Provider Name (Legal Business Name): TRACEY LYNN COOPER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S DOBSON RD STE 125
CHANDLER AZ
85286-6167
US

IV. Provider business mailing address

7010 E CHAUNCEY LN STE 225
PHOENIX AZ
85054-3117
US

V. Phone/Fax

Practice location:
  • Phone: 480-585-5200
  • Fax: 480-585-5233
Mailing address:
  • Phone: 480-585-5200
  • Fax: 480-585-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number263470
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: