Provider Demographics
NPI:1932082633
Name:MY DERM CLINICIAN
Entity type:Organization
Organization Name:MY DERM CLINICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIRSA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUARTULLO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, DCNP
Authorized Official - Phone:480-206-2245
Mailing Address - Street 1:3104 E INDIAN SCHOOL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6873
Mailing Address - Country:US
Mailing Address - Phone:480-590-6600
Mailing Address - Fax:480-590-5695
Practice Address - Street 1:3104 E INDIAN SCHOOL RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6873
Practice Address - Country:US
Practice Address - Phone:480-590-6600
Practice Address - Fax:480-590-5695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty