Provider Demographics
NPI:1205135787
Name:CARRICO, JENI LYN (CRNP)
Entity type:Individual
Prefix:
First Name:JENI
Middle Name:LYN
Last Name:CARRICO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-620-4855
Mailing Address - Fax:
Practice Address - Street 1:20945 GREAT MILLS RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-4369
Practice Address - Country:US
Practice Address - Phone:301-866-0080
Practice Address - Fax:301-866-0010
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009950363L00000X
MDR125002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily