Provider Demographics
NPI:1649954975
Name:CARROLL, JULIE ANN (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-1205
Mailing Address - Country:US
Mailing Address - Phone:401-413-3739
Mailing Address - Fax:
Practice Address - Street 1:45 ENFIELD DR
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-1205
Practice Address - Country:US
Practice Address - Phone:401-413-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN03655363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty