Healthcare Provider Details

I. General information

NPI: 1235990565
Provider Name (Legal Business Name): CARLEY ANN FLORENCE APRN, AGPCNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 E FORT UNION BLVD STE 105
MIDVALE UT
84047-5529
US

IV. Provider business mailing address

623 E FORT UNION BLVD STE 105
MIDVALE UT
84047-5529
US

V. Phone/Fax

Practice location:
  • Phone: 385-412-1660
  • Fax: 800-856-3698
Mailing address:
  • Phone: 385-412-1660
  • Fax: 800-856-3698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10160707-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number10160707-4405
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10160707-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: