Provider Demographics
NPI:1730173469
Name:CARROLL, BEVERLY (CRNA)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:OSTERMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:307 BOATNER RD
Mailing Address - Street 2:STE 114
Mailing Address - City:EGLIN AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542-1391
Mailing Address - Country:US
Mailing Address - Phone:850-883-8132
Mailing Address - Fax:850-883-8133
Practice Address - Street 1:307 BOATNER RD
Practice Address - Street 2:STE 114
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542-1391
Practice Address - Country:US
Practice Address - Phone:850-883-8132
Practice Address - Fax:850-883-8133
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2127482367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered