1033165600 NPI number — DR. PATRICIA CARLIN M D

Table of content: DR. PATRICIA CARLIN M D (NPI 1033165600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033165600 NPI number — DR. PATRICIA CARLIN M D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLIN
Provider First Name:
PATRICIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033165600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3564 AVALON PARK BLVD E
Provider Second Line Business Mailing Address:
STE 241
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32828-7365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-235-0692
Provider Business Mailing Address Fax Number:
321-235-0694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12301 LAKE UNDERHILL RD
Provider Second Line Business Practice Location Address:
STE 215
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32828-4511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-235-0692
Provider Business Practice Location Address Fax Number:
321-235-0694
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0101X , with the licence number:  23037 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: ME148185 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1490555 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111448200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com