Provider Demographics
NPI:1932291903
Name:CARROLL, JENNIFER G (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:G
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:CAROLE
Other - Last Name:GLANVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:26 WANZER HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:CT
Mailing Address - Zip Code:06784-2708
Mailing Address - Country:US
Mailing Address - Phone:203-258-4358
Mailing Address - Fax:845-790-2675
Practice Address - Street 1:310 E. 14TH STREET
Practice Address - Street 2:NY EYE & EAR INFIRMARY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-979-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003576367500000X
NY587562-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered