Provider Demographics
NPI:1639313968
Name:ENGLE, CAROLYN J (RN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:ENGLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 BROAD AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2459
Mailing Address - Country:US
Mailing Address - Phone:228-575-1507
Mailing Address - Fax:
Practice Address - Street 1:1340 BROAD AVE STE 420
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2459
Practice Address - Country:US
Practice Address - Phone:228-575-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR605441163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse