Provider Demographics
NPI:1417618729
Name:CARROLL, JAMES DAVID (FNP-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:CARROLL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2430 RESEARCH PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1093
Mailing Address - Country:US
Mailing Address - Phone:719-445-6242
Mailing Address - Fax:719-445-6332
Practice Address - Street 1:2430 RESEARCH PKWY STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1093
Practice Address - Country:US
Practice Address - Phone:719-445-6242
Practice Address - Fax:719-445-6332
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95068351163W00000X
CA95020376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse