Provider Demographics
NPI:1518911437
Name:CARLIN, MICHELLE ANN (CNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:CARLIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:GILLIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:3335 E INDIAN SCHOOL RD # 150H
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5025
Mailing Address - Country:US
Mailing Address - Phone:480-646-3221
Mailing Address - Fax:985-251-2854
Practice Address - Street 1:3335 E INDIAN SCHOOL RD STE 150H
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5025
Practice Address - Country:US
Practice Address - Phone:480-646-3221
Practice Address - Fax:985-251-2854
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3246363LA2200X, 363LP2300X, 363LP0808X, 363LP2300X
OHNP-08394363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000379862OtherANTHEM
OH2611981Medicaid
OH2027241Medicare PIN