Provider Demographics
NPI:1285122408
Name:TELLEZ, CAROLYN WENDY (PMH-NP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:WENDY
Last Name:TELLEZ
Suffix:
Gender:
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9802 W BELL RD UNIT 1217
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85372-7010
Mailing Address - Country:US
Mailing Address - Phone:520-244-4680
Mailing Address - Fax:623-666-5795
Practice Address - Street 1:9802 W BELL RD UNIT 1217
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85372-7010
Practice Address - Country:US
Practice Address - Phone:520-244-4680
Practice Address - Fax:623-666-5795
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN179578163WP0808X
AZAP11453363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ421574Medicaid