Healthcare Provider Details

I. General information

NPI: 1659871994
Provider Name (Legal Business Name): TRACI ANN ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 E SOUTHERN AVE
TEMPE AZ
85282-7531
US

IV. Provider business mailing address

3877 N 7TH ST STE 400
PHOENIX AZ
85014-5061
US

V. Phone/Fax

Practice location:
  • Phone: 480-897-7044
  • Fax:
Mailing address:
  • Phone: 602-258-6797
  • Fax: 602-248-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number292581
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: