Healthcare Provider Details

I. General information

NPI: 1063229862
Provider Name (Legal Business Name): CARLYNDA JO PASQUALE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 GRIER DR STE C
LAS VEGAS NV
89119-3746
US

IV. Provider business mailing address

4505 S MARYLAND PKWY # 453018
LAS VEGAS NV
89154-9900
US

V. Phone/Fax

Practice location:
  • Phone: 888-888-9930
  • Fax:
Mailing address:
  • Phone: 702-895-5920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number876690
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: