Individual
EDWARD JAMES CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1324 LAKELAND HILLS BLVD, LAKELAND, FL 33805-4543
(863) 687-1321
(863) 284-1730
Mailing address
1324 LAKELAND HILLS BLVD., ATTN: MANAGED CARE DEPT., LAKELAND, FL 33805
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
PA9101893
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291529400
—
FL
Enumeration date
04/06/2006
Last updated
05/01/2023
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