Healthcare Provider Details

I. General information

NPI: 1447149349
Provider Name (Legal Business Name): TRACI ANN NEWBERRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28471 N VISTANCIA BLVD STE 102
PEORIA AZ
85383-2092
US

IV. Provider business mailing address

12285 W ASHBY DR
PEORIA AZ
85383-3461
US

V. Phone/Fax

Practice location:
  • Phone: 623-327-8800
  • Fax: 623-327-8806
Mailing address:
  • Phone: 469-500-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number326456
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: