Provider Demographics
NPI:1679968770
Name:CARROLL, MONIQUE LYNETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:LYNETTE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:LYNETTE
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:19114 US HWY 281 N
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-496-7999
Mailing Address - Fax:210-494-1666
Practice Address - Street 1:19114 US HWY 281 N
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-496-7999
Practice Address - Fax:210-494-1666
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005631363A00000X
DCPA031105363A00000X
TXPA12299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant