Provider Demographics
NPI:1619713815
Name:CARRASCO, NOEMI (PMHNP)
Entity type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:NOEMI
Other - Middle Name:
Other - Last Name:CARRASCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:8607 N 59TH AVE STE C1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-5435
Mailing Address - Country:US
Mailing Address - Phone:602-481-1140
Mailing Address - Fax:
Practice Address - Street 1:8607 N 59TH AVE STE C1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-5435
Practice Address - Country:US
Practice Address - Phone:602-481-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ229032363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty