Provider Demographics
NPI:1568198992
Name:CARROLL, NICHOLE (ARNP)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 V ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:IA
Mailing Address - Zip Code:52236-8536
Mailing Address - Country:US
Mailing Address - Phone:319-331-1789
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTHGATE AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4357
Practice Address - Country:US
Practice Address - Phone:319-688-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH169964363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care