Healthcare Provider Details

I. General information

NPI: 1609756139
Provider Name (Legal Business Name): JILL JOLENE CARBAJAL APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 HARBOR RD
GROVE OK
74344-3525
US

IV. Provider business mailing address

3001 QUAIL SPRINGS PKWY FL 5
OKLAHOMA CITY OK
73134-2640
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-3223
  • Fax:
Mailing address:
  • Phone: 918-787-1909
  • Fax: 918-787-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number225593
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0127441
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: