Healthcare Provider Details

I. General information

NPI: 1174386940
Provider Name (Legal Business Name): AUSTIN MILL ACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AUSTIN MILL

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10210 N 92ND ST STE 104
SCOTTSDALE AZ
85258-4531
US

IV. Provider business mailing address

9024 E BLANCHE DR
SCOTTSDALE AZ
85260-2754
US

V. Phone/Fax

Practice location:
  • Phone: 480-493-0900
  • Fax:
Mailing address:
  • Phone: 480-262-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number303385
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number303385
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number303385
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: