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NPI Code Detail

MEDICARE: REBECCA ANN CARROLL FNP

MEDICARE: REBECCA ANN CARROLL 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 Practitioner21635CA

General Provider Information

NPI Number : 1982962759
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA ANN CARROLL FNP
Provider Business Mailing Address
First Line : 2760 FLETCHER PKWY
Second Line :
City : EL CAJON
State : CA
Zip : 92020-2110
Country : US
Telephone Number : 619-461-4411
Fax Number :
Provider Business Practice Location Address
First Line : 2760 FLETCHER PKWY
Second Line :
City : EL CAJON
State : CA
Zip : 92020-2110
Country : US
Telephone Number : 619-461-4411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2012
Last Update Date : 04/03/2015

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