Provider Demographics
NPI:1659641942
Name:CARLIN, JEANETTE ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:ELIZABETH
Last Name:CARLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1509 DOCTORS CIR
Practice Address - Street 2:BLDG C
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7403
Practice Address - Country:US
Practice Address - Phone:910-662-7500
Practice Address - Fax:910-662-7501
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007000363L00000X
NC220346363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1659641942Medicaid
SCNP4070Medicaid
NCNCU332BMedicare PIN
NCNCU332AMedicare PIN
SCNP4070Medicaid