Provider Demographics
NPI:1417349515
Name:CARROLL, ROBBIE JOE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ROBBIE
Middle Name:JOE
Last Name:CARROLL
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 EASTLAND DRIVE
Mailing Address - Street 2:FAMILY HEALTH SERVICES
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:208-734-3312
Mailing Address - Fax:208-734-5036
Practice Address - Street 1:402 6TH ST
Practice Address - Street 2:FAMILY HEALTH SERVICES
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350
Practice Address - Country:US
Practice Address - Phone:208-650-7941
Practice Address - Fax:208-436-0735
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0046673363L00000X
ID55534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID131825Medicare Oscar/Certification