Provider Demographics
NPI:1235769381
Name:CARROLL, ALICE LEEANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:LEEANN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1038
Mailing Address - Country:US
Mailing Address - Phone:812-885-3453
Mailing Address - Fax:
Practice Address - Street 1:1813 WILLOW ST STE 3
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-4276
Practice Address - Country:US
Practice Address - Phone:812-885-8941
Practice Address - Fax:812-885-8940
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF11190576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily