MEDICARE: MRS. BEVERLY CARROLL CRNA

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
1	367500000X	Certified Registered Nurse Anesthetist	ARNP2127482	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730173469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEVERLY CARROLL CRNA

Provider Business Mailing Address
First Line	:	307 BOATNER RD
Second Line	:	STE 114
City	:	EGLIN AFB
State	:	FL
Zip	:	32542-1391
Country	:	US
Telephone Number	:	850-883-8132
Fax Number	:	850-883-8133

Provider Business Practice Location Address
First Line	:	307 BOATNER RD
Second Line	:	STE 114
City	:	EGLIN AFB
State	:	FL
Zip	:	32542-1391
Country	:	US
Telephone Number	:	850-883-8132
Fax Number	:	850-883-8133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	10/08/2014

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