Individual
CARRIE JACOVINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
18589 N 59TH AVE, STE 101, GLENDALE, AZ 85308
(480) 776-1588
(602) 547-8700
Mailing address
7194 W MOHAWK LANE, GLENDALE, AZ 85308
(623) 376-0760
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2312
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
748600
—
AZ
Enumeration date
08/31/2006
Last updated
07/08/2007
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