Provider Demographics
NPI:1225136062
Name:CARROLL, JAMIE LYN (PA-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYN
Other - Last Name:HENNINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 N QUEEN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2762
Mailing Address - Country:US
Mailing Address - Phone:717-823-1702
Mailing Address - Fax:
Practice Address - Street 1:100 NORTH QUEEN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3550
Practice Address - Country:US
Practice Address - Phone:717-823-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052519363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant