Provider Demographics
NPI:1992484331
Name:SELLWOOD, CAROL MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIE
Last Name:SELLWOOD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 COLLINSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-0852
Mailing Address - Country:US
Mailing Address - Phone:814-935-7384
Mailing Address - Fax:
Practice Address - Street 1:980 COLLINSWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-0852
Practice Address - Country:US
Practice Address - Phone:814-935-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily