MEDICARE: AUSTIN MILL ACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	303385	AZ
2	363LF0000X	Family Nurse Practitioner	303385	AZ
3	363L00000X	Nurse Practitioner	303385	AZ

General Provider Information

NPI Number	:	1174386940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN MILL ACNP-BC

Provider Business Mailing Address
First Line	:	9024 E BLANCHE DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-2754
Country	:	US
Telephone Number	:	480-262-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	10210 N 92ND ST STE 104
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4531
Country	:	US
Telephone Number	:	480-493-0900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	08/27/2025

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