Provider Demographics
NPI:1134354350
Name:CARROLL, TERESA R (APN)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:R
Last Name:CARROLL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 S MARYLAND PKWY
Mailing Address - Street 2:#309
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2305
Mailing Address - Country:US
Mailing Address - Phone:702-791-0477
Mailing Address - Fax:702-791-6831
Practice Address - Street 1:3196 S MARYLAND PKWY
Practice Address - Street 2:#309
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2305
Practice Address - Country:US
Practice Address - Phone:702-791-0477
Practice Address - Fax:702-791-6831
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000722363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics