Provider Demographics
NPI:1700416708
Name:CARROLL, MEAGAN ASHLEY (BSN, RN)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:ASHLEY
Last Name:CARROLL
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 FASHION AVE FL 18
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7760
Mailing Address - Country:US
Mailing Address - Phone:407-756-8002
Mailing Address - Fax:
Practice Address - Street 1:463 7TH AVENUE
Practice Address - Street 2:18TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1001
Practice Address - Country:US
Practice Address - Phone:407-756-8002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-19
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NY863011-01163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician