Individual
MR. HARRY W CARROLL IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
3040 N WICKHAM RD STE 3, MELBOURNE, FL 32935-2369
(321) 456-9653
(321) 204-9168
Mailing address
3040 N WICKHAM RD STE 3, MELBOURNE, FL 32935-2369
(321) 456-9653
(321) 204-9168
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
11001267
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11001267
FL
Other
Enumeration date
02/01/2019
Last updated
04/15/2024
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