Healthcare Provider Details

I. General information

NPI: 1598041261
Provider Name (Legal Business Name): JOSEPH BRIAN CARROLL FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 VALPREDA RD
SAN MARCOS CA
92069-2973
US

IV. Provider business mailing address

396 N MAGNOLIA AVE
EL CAJON CA
92020-3908
US

V. Phone/Fax

Practice location:
  • Phone: 760-736-6767
  • Fax:
Mailing address:
  • Phone: 619-401-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number707882
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: