MEDICARE: HEATHER LYNN CARLISLE NP

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	AP5265	AZ
2	363LF0000X	Family Nurse Practitioner	AP5265	AZ
3	363LG0600X	Gerontology Nurse Practitioner	AP5265	AZ
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP5265	AZ

General Provider Information

NPI Number	:	1467734954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER LYNN CARLISLE NP

Provider Business Mailing Address
First Line	:	1718 E SPEEDWAY BLVD # 117
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-4515
Country	:	US
Telephone Number	:	520-285-8580
Fax Number	:	520-210-9386

Provider Business Practice Location Address
First Line	:	3210 E FORT LOWELL RD STE 103
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1682
Country	:	US
Telephone Number	:	520-285-8580
Fax Number	:	520-210-9386

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

Provider Enumeration Date	:	09/12/2011
Last Update Date	:	03/13/2024

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