Provider Demographics
NPI:1760443345
Name:CARROL, JENNIFER SARAH (ATC, PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SARAH
Last Name:CARROL
Suffix:
Gender:F
Credentials:ATC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022B 31ST AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-2725
Mailing Address - Country:US
Mailing Address - Phone:425-985-4411
Mailing Address - Fax:
Practice Address - Street 1:1 OLYMPIC PLZ
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5780
Practice Address - Country:US
Practice Address - Phone:719-866-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
WAPA60499313363A00000X
COPA.006687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer