Provider Demographics
NPI:1689621146
Name:CARROLL, DEBRA J (CRNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 TELFORD PIKE
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-2251
Mailing Address - Country:US
Mailing Address - Phone:215-723-7833
Mailing Address - Fax:
Practice Address - Street 1:211 TELFORD PIKE
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-2251
Practice Address - Country:US
Practice Address - Phone:215-723-7833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007611363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS48002Medicare UPIN