Healthcare Provider Details

I. General information

NPI: 1164031803
Provider Name (Legal Business Name): ERICA J CARR ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 W WALNUT ST
JACKSONVILLE IL
62650-1133
US

IV. Provider business mailing address

1517 W WALNUT ST
JACKSONVILLE IL
62650-1133
US

V. Phone/Fax

Practice location:
  • Phone: 217-243-6451
  • Fax:
Mailing address:
  • Phone: 217-528-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021503
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: