MEDICARE: MS. TRACY CONBOY PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP7751	AZ

General Provider Information

NPI Number	:	1164819918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACY CONBOY PMHNP

Provider Business Mailing Address
First Line	:	8160 E BUTHERUS DR STE 9
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-2523
Country	:	US
Telephone Number	:	602-377-7326
Fax Number	:	480-499-5526

Provider Business Practice Location Address
First Line	:	8160 E BUTHERUS DR STE 9
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-2523
Country	:	US
Telephone Number	:	602-377-7326
Fax Number	:	480-499-5526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	04/20/2015

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