Provider Demographics
NPI:1629443502
Name:AVILA, CAROL (ACNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:AVILA
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W CAMINO CASA VERDE STE 100
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-3569
Mailing Address - Country:US
Mailing Address - Phone:520-625-1760
Mailing Address - Fax:520-648-9496
Practice Address - Street 1:400 W CAMINO CASA VERDE STE 100
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-3569
Practice Address - Country:US
Practice Address - Phone:520-625-1760
Practice Address - Fax:520-648-9496
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8318363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care