Healthcare Provider Details

I. General information

NPI: 1144089038
Provider Name (Legal Business Name): TINA MARIE CARR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 N SWAN RD STE 121
TUCSON AZ
85712-4044
US

IV. Provider business mailing address

PO BOX 1150
TOMBSTONE AZ
85638-1150
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-3090
  • Fax:
Mailing address:
  • Phone: 152-041-2182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN243551
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number243551
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: