Provider Demographics
NPI:1740473693
Name:CARROLL, MARIDEL OPADA (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARIDEL
Middle Name:OPADA
Last Name:CARROLL
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:MARIDEL
Other - Middle Name:AGUILAR
Other - Last Name:SOHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6565 FANNIN ST
Mailing Address - Street 2:MGJ 11-002 NURSE PRACTITIONER PROGRAM
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-441-4595
Mailing Address - Fax:713-441-4427
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-441-4565
Practice Address - Fax:713-441-4427
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXA1106101363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health