Basic Information
| Provider Information | |||||||||
| NPI: | 1366992802 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARRILLO | ||||||||
| FirstName: | DANIELLE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3020 E CAMELBACK RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850167441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022649100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6020 E ARBOR AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809851700 | ||||||||
| FaxNumber: | 4803963659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2016 | ||||||||
| LastUpdateDate: | 02/20/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP9011 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.