MEDICARE: MRS. CARRIE JOANNE ROE-FITZGERALD FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209018635	IL

General Provider Information

NPI Number	:	1265084842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE JOANNE ROE-FITZGERALD FNP

Provider Business Mailing Address
First Line	:	6224 N TALISMAN TER
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-2749
Country	:	US
Telephone Number	:	309-648-5307
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 NE GLEN OAK AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61637-5280
Country	:	US
Telephone Number	:	309-655-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2019
Last Update Date	:	01/07/2025

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