Healthcare Provider Details

I. General information

NPI: 1427867688
Provider Name (Legal Business Name): CAROLYN M SHERIDAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N 40TH ST NURSING DIVISON
PHOENIX AZ
85034-1795
US

IV. Provider business mailing address

108 N 40TH ST NURSING DIVISON C/O CAROLYN SHERIDAN
PHOENIX AZ
85034-1795
US

V. Phone/Fax

Practice location:
  • Phone: 602-429-9807
  • Fax:
Mailing address:
  • Phone: 602-429-9807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number317778
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: