Provider Demographics
NPI:1780337907
Name:ASOLAS, CARLY MICHELLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:MICHELLE
Last Name:ASOLAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4044
Mailing Address - Country:US
Mailing Address - Phone:520-795-3090
Mailing Address - Fax:
Practice Address - Street 1:1505 N SWAN RD STE 121
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4044
Practice Address - Country:US
Practice Address - Phone:520-795-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ265482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily