Healthcare Provider Details

I. General information

NPI: 1861028771
Provider Name (Legal Business Name): TRACIA MILLER APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 E BASELINE RD STE 230
GILBERT AZ
85234-5450
US

IV. Provider business mailing address

508 MAIS DR
GEORGETOWN TX
78626-3050
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-3451
  • Fax:
Mailing address:
  • Phone: 512-247-8598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11034547
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32457
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015671A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024032091
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0036655
License Number StateOH
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP143993
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: