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General NPI Number Information
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NPI Number | 1700425758
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Entity Type | Individual
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Provider Name | CAROLYN EAVES APRN, MSN-FNP BC
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Gender | Female
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Dates
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Enumeration Date | 12/21/2019
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 247 NORTHSIDE DR STE B
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City | VALDOSTA
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State | GA
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Zip | 31602-1892
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Country | US
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Telephone | 229-253-1206
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 749
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City | OCILLA
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State | GA
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Zip | 31774-0749
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Country | US
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Telephone | 229-468-9166
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Fax | 229-468-9188
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11005571
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN199867
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License Number State | GA
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