Provider Demographics
NPI:1316922073
Name:CARROLL, JAIME (CRNP)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:6801 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3709
Mailing Address - Country:US
Mailing Address - Phone:251-266-3582
Mailing Address - Fax:251-266-3581
Practice Address - Street 1:6801 AIRPORT BLVD # 7B
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3709
Practice Address - Country:US
Practice Address - Phone:251-266-3582
Practice Address - Fax:251-266-3581
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9162423363L00000X
AL1-100787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306898600Medicaid
Q44251Medicare UPIN