Healthcare Provider Details

I. General information

NPI: 1427973866
Provider Name (Legal Business Name): ALYSSA NICOLE CARRILLO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 N RACINE AVE
CHICAGO IL
60642-7939
US

IV. Provider business mailing address

531 N RACINE AVE
CHICAGO IL
60642-7939
US

V. Phone/Fax

Practice location:
  • Phone: 312-376-3826
  • Fax:
Mailing address:
  • Phone: 312-376-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209036170
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: