Provider Demographics
NPI:1982655338
Name:WOLFE, TARRY ANNETTE (NP-C)
Entity Type:Individual
Prefix:
First Name:TARRY
Middle Name:ANNETTE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3160
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85117-4115
Mailing Address - Country:US
Mailing Address - Phone:480-983-0065
Mailing Address - Fax:480-671-4541
Practice Address - Street 1:625 N PLAZA DR
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-5501
Practice Address - Country:US
Practice Address - Phone:480-983-0065
Practice Address - Fax:480-671-4541
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4029363LP0808X
CA505067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty