Provider Demographics
NPI:1629866066
Name:CARROLL, STACI J
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:J
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 BRIAN CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3310
Mailing Address - Country:US
Mailing Address - Phone:615-556-1184
Mailing Address - Fax:
Practice Address - Street 1:2400 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4117
Practice Address - Country:US
Practice Address - Phone:615-320-0591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program