Healthcare Provider Details

I. General information

NPI: 1215414552
Provider Name (Legal Business Name): ANNA TRACEY WINN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132
US

IV. Provider business mailing address

7898 S FARM HOUSE LN
MIDVALE UT
84047-2847
US

V. Phone/Fax

Practice location:
  • Phone: 435-619-4757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number8262260-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number8262260-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: