Provider Demographics
NPI:1467104539
Name:STOLFA, CARRIE DAWN (NP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:DAWN
Last Name:STOLFA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:DAWN
Other - Last Name:STANDLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-5246
Mailing Address - Country:US
Mailing Address - Phone:512-732-2774
Mailing Address - Fax:
Practice Address - Street 1:1320 WONDER WORLD DR STE 105
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7558
Practice Address - Country:US
Practice Address - Phone:210-494-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036025363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner