MEDICARE: TRACI ANN ROBINSON

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	364SP0812X	Community Psychiatric/Mental Health Clinical Nurse Specialist	292581	AZ

General Provider Information

NPI Number	:	1659871994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI ANN ROBINSON

Provider Business Mailing Address
First Line	:	3877 N 7TH ST STE 400
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5061
Country	:	US
Telephone Number	:	602-258-6797
Fax Number	:	602-248-8119

Provider Business Practice Location Address
First Line	:	2123 E SOUTHERN AVE
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7531
Country	:	US
Telephone Number	:	480-897-7044
Fax Number	:

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

Provider Enumeration Date	:	02/13/2018
Last Update Date	:	07/01/2025

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