Provider Demographics
NPI:1467955351
Name:CARROLL, BRIDGET ANNE
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ANNE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FLAGSTONE DR
Mailing Address - Street 2:
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-8533
Mailing Address - Country:US
Mailing Address - Phone:856-693-6823
Mailing Address - Fax:
Practice Address - Street 1:800 HADDONFIELD RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2604
Practice Address - Country:US
Practice Address - Phone:856-663-7690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00700400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily