Provider Demographics
NPI:1356777395
Name:PEASE, CARLA MARIE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:PEASE
Suffix:
Gender:F
Credentials:AGPCNP-BC
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 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-2308
Mailing Address - Fax:
Practice Address - Street 1:3900 N SABINO CANYON RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-2130
Practice Address - Country:US
Practice Address - Phone:520-324-1301
Practice Address - Fax:520-324-1345
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR34202363LA2200X
AZ221557363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ597006Medicaid