Healthcare Provider Details

I. General information

NPI: 1073469532
Provider Name (Legal Business Name): CARLA RENEE POLLARD SP036611
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3528 I ST
PHILADELPHIA PA
19134-1449
US

IV. Provider business mailing address

128 RAMAH RD
BRIDGETON NJ
08302-6945
US

V. Phone/Fax

Practice location:
  • Phone: 856-275-6085
  • Fax:
Mailing address:
  • Phone: 856-275-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP036611
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number359171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: