Healthcare Provider Details

I. General information

NPI: 1760330336
Provider Name (Legal Business Name): CARISSA A. HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14815 W BELL RD STE 106
SURPRISE AZ
85374-7603
US

IV. Provider business mailing address

700 W WARNER RD
CHANDLER AZ
85225-2928
US

V. Phone/Fax

Practice location:
  • Phone: 623-312-3012
  • Fax: 480-398-8079
Mailing address:
  • Phone: 480-821-2838
  • Fax: 480-821-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337412
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN214905
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: