Individual
MS. JAQUELINE DENNISE CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1526 LOMBARD ST, PHILADELPHIA, PA 19146-1625
(215) 546-5960
Mailing address
830 MERCER ST, PHILADELPHIA, PA 19125-3519
(908) 472-6759
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
SP019576
PA
Other
Enumeration date
01/16/2019
Last updated
01/16/2019
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