Healthcare Provider Details

I. General information

NPI: 1447898721
Provider Name (Legal Business Name): SOPHIA BRACEY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2942 N 24TH ST STE 108A
PHOENIX AZ
85016-7849
US

IV. Provider business mailing address

2942 N 24TH ST STE 108A
PHOENIX AZ
85016-7849
US

V. Phone/Fax

Practice location:
  • Phone: 602-626-5152
  • Fax:
Mailing address:
  • Phone: 602-626-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345208
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number345208
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN311493
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number345208
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number345208
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberRN311493
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN311493
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number345208
License Number StateAZ
# 9
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number345208
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: