Provider Demographics
NPI:1437448859
Name:CARROLL, FAITH M (NP)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:M
Last Name:CARROLL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1101 N CENTRAL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1844
Mailing Address - Country:US
Mailing Address - Phone:602-307-5330
Mailing Address - Fax:602-253-3251
Practice Address - Street 1:1101 N CENTRAL AVE
Practice Address - Street 2:STE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1808
Practice Address - Country:US
Practice Address - Phone:602-307-5330
Practice Address - Fax:602-253-3251
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5218363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ932619Medicaid