Provider Demographics
NPI:1659660538
Name:INGRAM, CAROLYN ELIZABETH (FNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ELIZABETH
Last Name:INGRAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3800
Mailing Address - Country:US
Mailing Address - Phone:757-955-2828
Mailing Address - Fax:757-955-2829
Practice Address - Street 1:885 KEMPSVILLE RD
Practice Address - Street 2:SUITE 320
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3800
Practice Address - Country:US
Practice Address - Phone:757-955-2828
Practice Address - Fax:757-955-2829
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV1725AMedicare PIN