Provider Demographics
NPI:1467455477
Name:QUARTULLO, TIRSA CAROLINA (CFNP)
Entity type:Individual
Prefix:
First Name:TIRSA
Middle Name:CAROLINA
Last Name:QUARTULLO
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:TIRSA
Other - Middle Name:CAROLINA
Other - Last Name:BONCORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
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
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN118603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ829567Medicaid
AZ829567Medicaid
Q41951Medicare UPIN
102776Medicare ID - Type Unspecified