Provider Demographics
NPI:1306452909
Name:CARNEY, JACINTA HELENE LOUISA MAE (PA-C)
Entity type:Individual
Prefix:
First Name:JACINTA
Middle Name:HELENE LOUISA MAE
Last Name:CARNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACINTA
Other - Middle Name:HELENE LOUISA MAE
Other - Last Name:ARRIAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5055 E BROADWAY BLVD STE A100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3629
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:
Practice Address - Street 1:6130 N LA CHOLLA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3589
Practice Address - Country:US
Practice Address - Phone:520-742-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8947363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant