Provider Demographics
NPI:1487893517
Name:CARROLL, ERIKA B (FNP)
Entity type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:B
Last Name:CARROLL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 CENTRAL AVENUE
Mailing Address - Street 2:CHRIST COMMUNITY HEALTH SERVICES INC
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-260-8551
Mailing Address - Fax:901-260-8599
Practice Address - Street 1:2569 DOUGLASS AVENUE
Practice Address - Street 2:CHRIST COMMUNITY HEALTH SERVICES INC
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38114
Practice Address - Country:US
Practice Address - Phone:901-271-6200
Practice Address - Fax:901-260-8590
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR77930163W00000X
TN14071363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514069Medicaid