Healthcare Provider Details

I. General information

NPI: 1891112900
Provider Name (Legal Business Name): CARLY ANNE ERNST DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19389 N 59TH AVE
GLENDALE AZ
85308-6500
US

IV. Provider business mailing address

19389 N 59TH AVE
GLENDALE AZ
85308-6500
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-6000
  • Fax: 623-537-6014
Mailing address:
  • Phone: 623-537-6000
  • Fax: 623-537-6014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number007131
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number007131
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: