Healthcare Provider Details

I. General information

NPI: 1780337907
Provider Name (Legal Business Name): CARLY MICHELLE ASOLAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
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

1505 N SWAN RD
TUCSON AZ
85712-4044
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number265482
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: