Healthcare Provider Details

I. General information

NPI: 1780187096
Provider Name (Legal Business Name): ROBERT PATRICK CARROLL II FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 05/26/2025
Certification Date: 05/25/2025
Deactivation Date: 05/22/2023
Reactivation Date: 06/27/2023

III. Provider practice location address

70 S ORANGE AVE STE 235
LIVINGSTON NJ
07039-4915
US

IV. Provider business mailing address

70 S ORANGE AVE STE 235
LIVINGSTON NJ
07039-4915
US

V. Phone/Fax

Practice location:
  • Phone: 973-607-4911
  • Fax:
Mailing address:
  • Phone: 973-607-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11026128
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number351807
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ14999600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: