Provider Demographics
NPI:1073838900
Name:HERRLIE, CAROL ANNE (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANNE
Last Name:HERRLIE
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5253 BUCKS BAR RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-7869
Mailing Address - Country:US
Mailing Address - Phone:530-622-9124
Mailing Address - Fax:530-626-0677
Practice Address - Street 1:5253 BUCKS BAR RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-7869
Practice Address - Country:US
Practice Address - Phone:530-622-9124
Practice Address - Fax:530-626-0677
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-03
Last Update Date:2010-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN255133 FUNISNP3280364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA: ZZZ36132ZOtherMEDICARE PROVIDER NUMBER: ZZZ36132Z
CA: ZZZ36132ZOtherMEDICARE PROVIDER NUMBER: ZZZ36132Z