Provider Demographics
NPI:1821167065
Name:NOELL, CAROL ANN-MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN-MARIE
Last Name:NOELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:N
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1400 BISHOP ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4244
Mailing Address - Country:US
Mailing Address - Phone:904-287-2794
Mailing Address - Fax:904-287-5362
Practice Address - Street 1:1400 BISHOP ESTATES RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-4244
Practice Address - Country:US
Practice Address - Phone:904-287-2794
Practice Address - Fax:904-287-5362
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102064363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS10319Medicare UPIN
FLE8397WMedicare PIN