Provider Demographics
NPI:1336318294
Name:CARROZ, MINNERVA (NP)
Entity Type:Individual
Prefix:
First Name:MINNERVA
Middle Name:
Last Name:CARROZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9043 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7049
Mailing Address - Country:US
Mailing Address - Phone:623-776-2065
Mailing Address - Fax:
Practice Address - Street 1:9043 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345
Practice Address - Country:US
Practice Address - Phone:623-776-2065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2941363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner