Provider Demographics
NPI:1831449099
Name:DECARLO, SANDRA LEE (DNP, FNP-C, CWOCN)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE
Last Name:DECARLO
Suffix:
Gender:F
Credentials:DNP, FNP-C, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9139 W THUNDERBIRD RD STE 175
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4998
Mailing Address - Country:US
Mailing Address - Phone:623-776-6133
Mailing Address - Fax:623-974-3318
Practice Address - Street 1:9139 W THUNDERBIRD RD STE 175
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4998
Practice Address - Country:US
Practice Address - Phone:623-776-6133
Practice Address - Fax:623-974-3318
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ181137Medicare PIN