Provider Demographics
NPI:1497724595
Name:CARROLL, TAMMY L (CRNA)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:L
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP ANESTHESIA DEPT.
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-4195
Practice Address - Fax:904-244-4908
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-03-24
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Provider Licenses
StateLicense IDTaxonomies
FLARNP2934962363L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA627820832BMedicaid
FL3067301-00Medicaid
GA627820832AMedicaid
FLU4400ZMedicare PIN
GA627820832AMedicaid