Individual
OLGA B CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
655 W 8TH ST, JACKSONVILLE, FL 32209-6511
(904) 244-0411
Mailing address
5432 LONDON LAKE DR, JACKSONVILLE, FL 32258-5397
(904) 210-6954
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
006235
GA
367H00000X
Anesthesiologist Assistant
Primary
AA124
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014251100
—
FL
01
—
G01UT
BCBS
FL
Enumeration date
10/21/2011
Last updated
06/06/2017
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