Jaqueline Dennise Carroll, CRNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

SP019576 Issued in PA

Practice address

1526 Lombard St
Philadelphia, PA 19146-1625

Phone

(215) 546-5960

NPI assigned

Jan 16, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• University of Penn - Medical Group

  • Hospitalist Physician
  • Philadelphia, PA
  • NPI 1053447151
  Medicare reassignment NPD
• University of Penn-Medical Group

  • Infectious Disease Physician
  • Philadelphia, PA
  • NPI 1194832899
  Medicare reassignment NPD
• University of Penn-Medical Group

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1386751089
  NPD
• University of Penn-Medical Group

  • Surgical Oncology Physician
  • Philadelphia, PA
  • NPI 1871981985
  NPD
• HCR Manor Care Medical Services of Florida LLC

  • Nurse Practitioner
  • Toledo, OH
  • NPI 1881861052
  NPD
• HCR Manorcare Medical Services of Florida LLC

  • Nurse Practitioner
  • Toledo, OH
  • NPI 1386750420
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547596800000",
    "number": "1255805990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 MERCER ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191253519",
            "telephone_number": "908-472-6759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 LOMBARD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191461625",
            "telephone_number": "215-546-5960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JAQUELINE",
        "middle_name": "DENNISE",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-16",
        "last_updated": "2019-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "PA",
            "license": "SP019576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Lynne Carrino, MS
• Malvin Carrion, A.T.C.
• Katrina L Carroll-Haskins
• Bryn Marie Carroll, MD
• Fred Carroll, M.D.
• Jillian Carroll, MA, MS
• Joseph Carroll, PA-C
• Judith S Carroll, M.D.
• Katie Carroll, CRNA
• Leslie Seton Carroll, MD

• Primary Care Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Primary Care Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.