Healthcare Provider Details

I. General information

NPI: 1700425758
Provider Name (Legal Business Name): CAROLYN EAVES APRN, MSN-FNP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN EAVES REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 12/21/2019
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 NORTHSIDE DR STE B
VALDOSTA GA
31602-1892
US

IV. Provider business mailing address

PO BOX 749
OCILLA GA
31774-0749
US

V. Phone/Fax

Practice location:
  • Phone: 229-253-1206
  • Fax:
Mailing address:
  • Phone: 229-468-9166
  • Fax: 229-468-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11005571
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN199867
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: