Provider Demographics
NPI:1205958386
Name:DANIEL, TRACY A (PA)
Entity type:Individual
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First Name:TRACY
Middle Name:A
Last Name:DANIEL
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Gender:F
Credentials:PA
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Mailing Address - Street 1:4600 S MILL AVE
Mailing Address - Street 2:STE 280
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6850
Mailing Address - Country:US
Mailing Address - Phone:480-305-2888
Mailing Address - Fax:480-305-2889
Practice Address - Street 1:3200 S GILBERT RD
Practice Address - Street 2:UCEXTRA
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-5107
Practice Address - Country:US
Practice Address - Phone:480-471-6404
Practice Address - Fax:480-219-4915
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2016-10-31
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Provider Licenses
StateLicense IDTaxonomies
AZ3067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ618135Medicaid
AZ618135Medicaid