Provider Demographics
NPI:1750062980
Name:AMY CARRILLO NP, PLLC
Entity type:Organization
Organization Name:AMY CARRILLO NP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:432-770-2107
Mailing Address - Street 1:10555 W HACIENDA DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-7208
Mailing Address - Country:US
Mailing Address - Phone:432-770-2107
Mailing Address - Fax:
Practice Address - Street 1:808 TOWER DR STE 10
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4270
Practice Address - Country:US
Practice Address - Phone:432-770-2107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care