Provider Demographics
NPI:1780187096
Name:CARROLL, ROBERT PATRICK II (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PATRICK
Last Name:CARROLL
Suffix:II
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-7412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1619 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7412
Practice Address - Country:US
Practice Address - Phone:646-416-5752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2024-01-25
Deactivation Date:2023-05-22
Deactivation Code:
Reactivation Date:2023-06-27
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026128363LF0000X
NJ26NJ14999600363LF0000X
NY351807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily