MEDICARE: MARIAH DESIREE ISLAS 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	363LP2300X	Primary Care Nurse Practitioner	228691	AZ

General Provider Information

NPI Number	:	1659267078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH DESIREE ISLAS NP

Provider Business Mailing Address
First Line	:	11921 E RYSCOTT CIR
Second Line	:
City	:	VAIL
State	:	AZ
Zip	:	85641-0259
Country	:	US
Telephone Number	:	520-289-6441
Fax Number	:

Provider Business Practice Location Address
First Line	:	9525 E OLD SPANISH TRL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85748-6631
Country	:	US
Telephone Number	:	773-531-8069
Fax Number	:

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

Provider Enumeration Date	:	06/13/2025
Last Update Date	:	06/13/2025

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