MEDICARE: CHARINALE ELORTA PRADO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP11032	AZ

General Provider Information

NPI Number	:	1700212271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARINALE ELORTA PRADO NP

Provider Business Mailing Address
First Line	:	PO BOX 749495
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-9495
Country	:	US
Telephone Number	:	855-963-2100
Fax Number	:	813-321-1296

Provider Business Practice Location Address
First Line	:	77 W FOREST AVE STE 301
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-1483
Country	:	US
Telephone Number	:	928-635-7307
Fax Number	:	928-774-3844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	03/09/2026

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Directions to “ CHARINALE ELORTA PRADO NP” Practice Location

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