Provider Demographics
NPI:1912116922
Name:NAVARRE, CARROLL (NP)
Entity type:Individual
Prefix:
First Name:CARROLL
Middle Name:
Last Name:NAVARRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 PHELPS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210
Mailing Address - Country:US
Mailing Address - Phone:559-935-4374
Mailing Address - Fax:559-935-4316
Practice Address - Street 1:1145 PHELPS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210
Practice Address - Country:US
Practice Address - Phone:559-935-4374
Practice Address - Fax:559-935-4316
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379864363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner