Provider Demographics
NPI:1790191237
Name:CARLSON, AMY (NP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10014 N CARDON GRANDE TRL
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0477
Mailing Address - Country:US
Mailing Address - Phone:618-567-1252
Mailing Address - Fax:520-200-3463
Practice Address - Street 1:6200 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3529
Practice Address - Country:US
Practice Address - Phone:618-567-1252
Practice Address - Fax:520-200-3464
Is Sole Proprietor?:No
Enumeration Date:2014-07-04
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP5696363LG0600X
AZTAP5696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology