Healthcare Provider Details

I. General information

NPI: 1629640354
Provider Name (Legal Business Name): CAROLYN TOTH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 HIGHWAY 36 W
ROSEVILLE MN
55113-3902
US

IV. Provider business mailing address

4547 TENNYSON ST
DENVER CO
80212-2526
US

V. Phone/Fax

Practice location:
  • Phone: 763-412-1993
  • Fax:
Mailing address:
  • Phone: 630-991-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996689-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN.1675589
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: