Provider Demographics
NPI:1457520603
Name:CARROLL, SONJA DENISE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SONJA
Middle Name:DENISE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 PALMERA ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-8326
Mailing Address - Country:US
Mailing Address - Phone:407-294-5859
Mailing Address - Fax:
Practice Address - Street 1:780 PALMERA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-8326
Practice Address - Country:US
Practice Address - Phone:407-294-5859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3079942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAS066ZMedicare UPIN