Healthcare Provider Details

I. General information

NPI: 1922938000
Provider Name (Legal Business Name): ALLY BREE CARROLL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 HIGHWAY 466
LADY LAKE FL
32159-3722
US

IV. Provider business mailing address

7361 N IRELAND DR
CITRUS SPRINGS FL
34434-7417
US

V. Phone/Fax

Practice location:
  • Phone: 866-492-3627
  • Fax:
Mailing address:
  • Phone: 352-587-4244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11038952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: