Healthcare Provider Details

I. General information

NPI: 1225546021
Provider Name (Legal Business Name): TRACY LEIGH THOMPSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 E RIGGS RD STE 114
SUN LAKES AZ
85248-7760
US

IV. Provider business mailing address

16200 ADDISON RD STE 155
ADDISON TX
75001-5333
US

V. Phone/Fax

Practice location:
  • Phone: 480-505-2450
  • Fax:
Mailing address:
  • Phone: 972-417-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number239349
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704262656
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: