| Doctor Name: | MISS JESSICA L CARROLL |
| NPI Number: | 1942300090 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 25MP00088900 |
| Business Practice Address: | 9501 Ventnor Ave Margate City, NJ - 084022218 |
| Business Phone Number: | 6098236161 |
| Business Fax Number: | 6098233413 |
| Mailing Address: | 13421 Kelvin Ave, PHILADELPHIA |
| State: | PA |
| Postal Code: | 191161327 |
| Phone Number: | 2674746792 |
| Fax Number: | |
| NPI Enumeration Date: | 09/25/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 25MP00088900 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |