Provider Demographics
NPI:1265084842
Name:ROE-FITZGERALD, CARRIE JOANNE (FNP)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JOANNE
Last Name:ROE-FITZGERALD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:JOANNE
Other - Last Name:ROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:6224 N TALISMAN TER
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2749
Mailing Address - Country:US
Mailing Address - Phone:309-648-5307
Mailing Address - Fax:
Practice Address - Street 1:530 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-5280
Practice Address - Country:US
Practice Address - Phone:309-655-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily