Healthcare Provider Details

I. General information

NPI: 1982655338
Provider Name (Legal Business Name): TARRY ANNETTE WOLFE DNP, FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N PLAZA DR
APACHE JUNCTION AZ
85120-5501
US

IV. Provider business mailing address

11361 N 99TH AVE
PEORIA AZ
85345-5470
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-0065
  • Fax: 480-671-4541
Mailing address:
  • Phone: 480-983-0065
  • Fax: 480-671-4541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number505067
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP4029
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: