Provider Demographics
NPI:1053798199
Name:BORN, CARMEN PATRICIA (PMHNP-BC, RN, LMT)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:PATRICIA
Last Name:BORN
Suffix:
Gender:F
Credentials:PMHNP-BC, RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:35641 W COSTA BLANCA DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-5869
Mailing Address - Country:US
Mailing Address - Phone:443-823-5908
Mailing Address - Fax:
Practice Address - Street 1:35641 W COSTA BLANCA DR
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-5869
Practice Address - Country:US
Practice Address - Phone:443-823-5908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ295014363LP0808X
AZ29408225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist