Provider Demographics
NPI:1124187844
Name:CARROLL, HARLAN P (MA)
Entity Type:Individual
Prefix:
First Name:HARLAN
Middle Name:P
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 UNIVERSITY BLVD S STE 500
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-7405
Mailing Address - Country:US
Mailing Address - Phone:904-858-1912
Mailing Address - Fax:
Practice Address - Street 1:3627 UNIVERSITY BLVD S STE 500
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-7405
Practice Address - Country:US
Practice Address - Phone:904-858-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1612231H00000X
FLAY2760231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist