Healthcare Provider Details

I. General information

NPI: 1548943830
Provider Name (Legal Business Name): LORIN A CARROLL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 W AZEELE ST STE 100
TAMPA FL
33609-3577
US

IV. Provider business mailing address

3010 W AZEELE ST STE 100
TAMPA FL
33609-3577
US

V. Phone/Fax

Practice location:
  • Phone: 813-251-0194
  • Fax: 813-254-0279
Mailing address:
  • Phone: 813-251-0194
  • Fax: 813-254-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11026721
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: