Healthcare Provider Details

I. General information

NPI: 1306187158
Provider Name (Legal Business Name): TRACY D OSBORNE MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 S HIGHWAY 95
FORT MOHAVE AZ
86426-9225
US

IV. Provider business mailing address

5301 MUDDY STRING RD # 7249
STAR VALLEY RANCH WY
83127-5222
US

V. Phone/Fax

Practice location:
  • Phone: 928-542-2938
  • Fax:
Mailing address:
  • Phone: 928-542-2938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number47671
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5471065
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4907
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: