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General NPI Number Information
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NPI Number | 1538205851
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Entity Type | Individual
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Provider Name | TRACY LYNNE CUMBERLAND PA-C, PHD
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 5750 W THUNDERBIRD RD STE B200
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City | GLENDALE
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State | AZ
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Zip | 85306-4664
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Country | US
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Telephone | 602-375-1700
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Fax | 602-978-1225
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Provider Business Mailing Address
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Address Line | 14044 W CAMELBACK RD STE 118J
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-9428
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Country | US
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Telephone | 623-547-2600
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Fax | 623-547-1899
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C01254
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7357
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License Number State | AZ
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