Provider Demographics
NPI:1063912541
Name:BULLOCK, CAROL LEIGH (CRNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LEIGH
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CHATEAU DR SW STE 160
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6437
Mailing Address - Country:US
Mailing Address - Phone:256-880-6542
Mailing Address - Fax:256-880-6543
Practice Address - Street 1:250 CHATEAU DR SW STE 160
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6437
Practice Address - Country:US
Practice Address - Phone:256-880-6542
Practice Address - Fax:256-880-6543
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF01180966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-098593OtherAL BOARD OF NURSING
F01180966OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD