Provider Demographics
NPI:1275866808
Name:CARROLL, DAWN LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:LYNN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:LYNN
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:11528 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-1442
Mailing Address - Country:US
Mailing Address - Phone:727-868-2151
Mailing Address - Fax:727-819-8362
Practice Address - Street 1:9238 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4853
Practice Address - Country:US
Practice Address - Phone:727-849-8491
Practice Address - Fax:727-849-3483
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2822692363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCF568ZMedicare PIN