Provider Demographics
NPI:1659267078
Name:ISLAS, MARIAH DESIREE (NP)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:DESIREE
Last Name:ISLAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11921 E RYSCOTT CIR
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-0259
Mailing Address - Country:US
Mailing Address - Phone:520-289-6441
Mailing Address - Fax:
Practice Address - Street 1:9525 E OLD SPANISH TRL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-6631
Practice Address - Country:US
Practice Address - Phone:773-531-8069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ228691363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care