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Individual
JONATHAN CARROLL
Active
Individual
JONATHAN CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9108305
FL
363AM0700X
Medical Physician Assistant
PA9108305
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014722600
—
FL
Enumeration date
08/28/2014
Last updated
05/09/2017
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