Provider Demographics
NPI:1700425758
Name:EAVES, CAROLYN (APRN, MSN-FNP BC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:EAVES
Suffix:
Gender:F
Credentials:APRN, MSN-FNP BC
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:EAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-0749
Mailing Address - Country:US
Mailing Address - Phone:229-468-9166
Mailing Address - Fax:229-468-9188
Practice Address - Street 1:247 NORTHSIDE DR STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1892
Practice Address - Country:US
Practice Address - Phone:229-253-1206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005571363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty