Provider Demographics
NPI:1194780635
Name:MCCARTER, COLLEEN A (FNP)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:A
Last Name:MCCARTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9832 E GLENCOVE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-4444
Mailing Address - Country:US
Mailing Address - Phone:480-220-8205
Mailing Address - Fax:480-984-8792
Practice Address - Street 1:6828 E BROWN RD STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3761
Practice Address - Country:US
Practice Address - Phone:480-981-8650
Practice Address - Fax:480-981-1563
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN0345797363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
2Z2150OtherHEALTHNET
AZ917700Medicaid
2Z2150OtherHEALTHNET
83132Medicare ID - Type Unspecified