Provider Demographics
NPI:1669422085
Name:STUART, CARLA R (NP)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:R
Last Name:STUART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:R
Other - Last Name:SHIRLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-972-9590
Practice Address - Street 1:13640 N PLAZA DEL RIO BLVD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4846
Practice Address - Country:US
Practice Address - Phone:623-876-3800
Practice Address - Fax:623-972-9590
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN070391363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ618043Medicaid
AZP27005Medicare UPIN
AZP00094743Medicare PIN
AZZ76850Medicare PIN
AZZ76808Medicare PIN