Provider Demographics
NPI:1922673946
Name:ESTORNELL, CAROLYN (FNP-C)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:ESTORNELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23000 MOAKLEY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2916
Mailing Address - Country:US
Mailing Address - Phone:301-475-5555
Mailing Address - Fax:301-475-5914
Practice Address - Street 1:23000 MOAKLEY ST STE 102
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2916
Practice Address - Country:US
Practice Address - Phone:301-475-5555
Practice Address - Fax:301-475-5914
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220883363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily