Provider Demographics
NPI:1336564731
Name:MCKINNON, CAROL (ARNP, NP-C)
Entity type:Individual
Prefix:MR
First Name:CAROL
Middle Name:
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:ARNP, NP-C
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:KREEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:888-973-8821
Practice Address - Street 1:880 SW 145TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-6171
Practice Address - Country:US
Practice Address - Phone:866-849-0692
Practice Address - Fax:888-973-8821
Is Sole Proprietor?:No
Enumeration Date:2014-02-22
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0033379363LF0000X
AL3-001637363LF0000X
TN36525363LF0000X
TX1191574363LF0000X
FLARNP9278438363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily