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General NPI Number Information
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NPI Number | 1932082633
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Entity Type | Organization
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Legal Business Name | MY DERM CLINICIAN
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 3104 E INDIAN SCHOOL RD STE 100
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City | PHOENIX
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State | AZ
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Zip | 85016-6873
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Country | US
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Telephone | 480-590-6600
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Fax | 480-590-5695
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Provider Business Mailing Address
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Address Line | 3104 E INDIAN SCHOOL RD STE 100
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City | PHOENIX
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State | AZ
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Zip | 85016-6873
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Country | US
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Telephone | 480-590-6600
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Fax | 480-590-5695
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | TIRSA QUARTULLO
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Credential | DNP, DCNP
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Telephone | 480-206-2245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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