Provider Demographics
NPI:1952925174
Name:CARROLL, EMILY ANN (RN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 E MIMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3519
Mailing Address - Country:US
Mailing Address - Phone:361-648-1102
Mailing Address - Fax:
Practice Address - Street 1:2402 E MIMOSA AVE
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3519
Practice Address - Country:US
Practice Address - Phone:361-648-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX983120163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse