Provider Demographics
NPI:1164875621
Name:ROLLINS, CARMEN NICOLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:NICOLE
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:CARMEN
Other - Middle Name:NICOLE
Other - Last Name:BLOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:PINE PRAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70576-0542
Mailing Address - Country:US
Mailing Address - Phone:337-599-2800
Mailing Address - Fax:337-599-2210
Practice Address - Street 1:1121 WALNUT ST.
Practice Address - Street 2:
Practice Address - City:PINE PRAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70576-0542
Practice Address - Country:US
Practice Address - Phone:337-599-2800
Practice Address - Fax:337-599-2210
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily