Provider Demographics
NPI:1790962421
Name:SPILLMAN, CAROL (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SPILLMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 6TH AVE
Mailing Address - Street 2:#1H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2567
Mailing Address - Country:US
Mailing Address - Phone:718-869-0362
Mailing Address - Fax:
Practice Address - Street 1:501 6TH ST
Practice Address - Street 2:#2H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3671
Practice Address - Country:US
Practice Address - Phone:718-780-3566
Practice Address - Fax:718-780-3715
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381222363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics