Provider Demographics
NPI:1598107658
Name:SCALMATO, CARLA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:SCALMATO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:MARIE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1760 E PECOS RD STE 235
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-3207
Mailing Address - Country:US
Mailing Address - Phone:480-813-0944
Mailing Address - Fax:
Practice Address - Street 1:1760 E PECOS RD STE 235
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-3207
Practice Address - Country:US
Practice Address - Phone:480-813-0944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ833452Medicaid
AZZ160773Medicare PIN