Individual
CAROLYN RENEE WAGNER VON HOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3591 S MERCY RD STE 204, GILBERT, AZ 85297-2240
(866) 974-2673
(866) 939-2673
Mailing address
18444 N 25TH AVE STE 310, PHOENIX, AZ 85023-1266
(866) 974-2673
(866) 939-2673
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4954
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4954
ARIZONA BOARD OF PHYSICIAN ASSISTANTS
AZ
05
—
651920
—
AZ
Enumeration date
09/21/2011
Last updated
08/11/2025
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