Healthcare Provider Details

I. General information

NPI: 1104168889
Provider Name (Legal Business Name): ANNA CARROLL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 PARK AVE
ADAMSVILLE TN
38310-2461
US

IV. Provider business mailing address

80 ENOCH BLVD SUITE A
SAVANNAH TN
38372-2231
US

V. Phone/Fax

Practice location:
  • Phone: 615-673-6737
  • Fax: 800-474-4039
Mailing address:
  • Phone: 731-926-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17508
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: