Provider Demographics
NPI:1154673606
Name:ROLLINS, CAROLYN A (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD # 100129
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-3003
Mailing Address - Country:US
Mailing Address - Phone:352-273-5505
Mailing Address - Fax:352-273-5515
Practice Address - Street 1:1600 SW ARCHER RD # 100129
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-4524
Practice Address - Country:US
Practice Address - Phone:352-273-5505
Practice Address - Fax:352-273-5515
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9169940363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008991400Medicaid
HH694WOtherMEDICARE PTAN
HH694WOtherMEDICARE PTAN