Healthcare Provider Details

I. General information

NPI: 1437448859
Provider Name (Legal Business Name): FAITH M CARROLL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N CENTRAL AVE STE 200
PHOENIX AZ
85004-1808
US

IV. Provider business mailing address

1101 N CENTRAL AVE STE 200
PHOENIX AZ
85004-1844
US

V. Phone/Fax

Practice location:
  • Phone: 602-307-5330
  • Fax: 602-253-3251
Mailing address:
  • Phone: 602-307-5330
  • Fax: 602-253-3251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP5218
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: