Provider Demographics
NPI:1376078196
Name:CARLILE, MARANDA STAR (FNP-BC)
Entity type:Individual
Prefix:
First Name:MARANDA
Middle Name:STAR
Last Name:CARLILE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 E RIVERSIDE DR STE A-1A
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6758
Mailing Address - Country:US
Mailing Address - Phone:435-565-1384
Mailing Address - Fax:435-355-3938
Practice Address - Street 1:352 E RIVERSIDE DR STE A-1A
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6758
Practice Address - Country:US
Practice Address - Phone:435-565-1384
Practice Address - Fax:435-355-3938
Is Sole Proprietor?:No
Enumeration Date:2017-04-30
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10110363LF0000X
NVAPRN002492363L00000X
UT375828-4405363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health