MEDICARE: FAITH M CARROLL N.P.

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP5218	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437448859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAITH M CARROLL N.P.

Provider Business Mailing Address
First Line	:	1101 N CENTRAL AVE STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1844
Country	:	US
Telephone Number	:	602-307-5330
Fax Number	:	602-253-3251

Provider Business Practice Location Address
First Line	:	1101 N CENTRAL AVE
Second Line	:	STE 200
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1808
Country	:	US
Telephone Number	:	602-307-5330
Fax Number	:	602-253-3251

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

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	07/20/2016

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