Provider Demographics
NPI:1609128255
Name:FOX, CARLIE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:
Last Name:FOX
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Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:1688 E BOSTON ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6220
Mailing Address - Country:US
Mailing Address - Phone:480-855-0085
Mailing Address - Fax:480-855-0086
Practice Address - Street 1:1688 E BOSTON ST
Practice Address - Street 2:101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6220
Practice Address - Country:US
Practice Address - Phone:480-855-0085
Practice Address - Fax:480-855-0086
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ5248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant