| NPI | 1578163911 |
|---|---|
| Former Name | STACY CARROLL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 3371168) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM RN-75836) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP030481) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R248169) | |
| 363LF0000X Nurse Practitioner, Family (Licence: PA MJ9131614) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MD MJ6513813) | |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2025-11-18 |