Provider Demographics
NPI:1417618729
Name:CARROLL, JAMES DAVID (FNP-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:CARROLL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 PIMENTEL DR
Mailing Address - Street 2:
Mailing Address - City:DENAIR
Mailing Address - State:CA
Mailing Address - Zip Code:95316-8577
Mailing Address - Country:US
Mailing Address - Phone:120-964-8487
Mailing Address - Fax:
Practice Address - Street 1:1739 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2714
Practice Address - Country:US
Practice Address - Phone:209-448-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95068351163W00000X
CA95020376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse