MEDICARE: TRACI ANN VOPALENSKY FNP

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	363LF0000X	Family Nurse Practitioner	AP221855	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP221855	OTHER	AZ	STATE OF ARIZONA

General Provider Information

NPI Number	:	1942855705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI ANN VOPALENSKY FNP

Provider Business Mailing Address
First Line	:	4900 N SCOTTSDALE RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7652
Country	:	US
Telephone Number	:	480-874-5806
Fax Number	:	480-210-8194

Provider Business Practice Location Address
First Line	:	4900 N SCOTTSDALE RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7652
Country	:	US
Telephone Number	:	480-874-5806
Fax Number	:	480-210-8194

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

Provider Enumeration Date	:	08/07/2019
Last Update Date	:	12/24/2020

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