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General NPI Number Information
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NPI Number | 1952970584
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Entity Type | Individual
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Provider Name | TANYA CARROCCIO DNP
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Gender | Female
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Dates
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Enumeration Date | 06/18/2021
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 16952 W BELL RD STE E-304
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City | SURPRISE
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State | AZ
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Zip | 85374-8951
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Country | US
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Telephone | 541-306-1338
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Fax |
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Provider Business Mailing Address
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Address Line | 12936 W MICHELTORENA DR
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-1512
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP11702
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License Number State | AZ
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