Active NPI
Kathleen M Carroll, M.D.
- Psychiatry Physician
- Brandon, FL
National Provider Identifier
1710970595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- ME0076947
- Practice address
- 336 E Bloomingdale Ave
Brandon, FL 33511-8155 - Phone
- (813) 689-2466
- Fax
- (813) 689-0435
- NPI assigned
- Aug 26, 2005
- Reactivated
- Apr 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | ME0076947 | FL | Primary |
Addresses
Primary practice location
336 E Bloomingdale Ave
Brandon, FL 33511-8155
Mailing address
336 E Bloomingdale Ave
Brandon, FL 33511-8155
Phone (813) 689-2466
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 79367 | Other | FL | BCBS ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0076947 | FL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1710970595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "336 E BLOOMINGDALE AVE",
"city": "BRANDON",
"state": "FL",
"postal_code": "335118155",
"telephone_number": "813-689-2466",
"fax_number": "813-689-0435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "336 E BLOOMINGDALE AVE",
"city": "BRANDON",
"state": "FL",
"postal_code": "335118155",
"telephone_number": "813-689-2466",
"fax_number": "813-689-0435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "KATHLEEN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-26",
"last_updated": "2026-07-13",
"deactivation_date": "2006-03-27",
"reactivation_date": "2006-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "FL",
"license": "ME0076947",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS ID",
"identifier": "79367",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brandon, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.