Provider Demographics
NPI:1730899840
Name:CARROLL, CHANTE (AG-ACNP-BC)
Entity type:Individual
Prefix:MS
First Name:CHANTE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 PINE HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5132
Mailing Address - Country:US
Mailing Address - Phone:410-925-0990
Mailing Address - Fax:
Practice Address - Street 1:312 MARTIN LUTHER KING JR BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1221
Practice Address - Country:US
Practice Address - Phone:410-777-8971
Practice Address - Fax:877-595-7180
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR191443363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care