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NPI Code Detail

MEDICARE: MRS. CARRIE JOANNE ROE-FITZGERALD FNP

MEDICARE: MRS. CARRIE JOANNE ROE-FITZGERALD FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209018635IL

General Provider Information

NPI Number : 1265084842
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CARRIE JOANNE ROE-FITZGERALD FNP
Provider Business Mailing Address
First Line : 6224 N TALISMAN TER
Second Line :
City : PEORIA
State : IL
Zip : 61615-2749
Country : US
Telephone Number : 309-648-5307
Fax Number :
Provider Business Practice Location Address
First Line : 530 NE GLEN OAK AVE
Second Line :
City : PEORIA
State : IL
Zip : 61637-5280
Country : US
Telephone Number : 309-655-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2019
Last Update Date : 01/07/2025

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