Provider Demographics
NPI:1023396850
Name:VINCENT, CARLA JEAN (CRNP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JEAN
Last Name:VINCENT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:JEAN
Other - Last Name:VINCENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:412 GRAVEL POND RD
Mailing Address - Street 2:#3
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-8767
Mailing Address - Country:US
Mailing Address - Phone:570-587-1355
Mailing Address - Fax:570-587-1355
Practice Address - Street 1:412 GRAVEL POND RD
Practice Address - Street 2:#3
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-8767
Practice Address - Country:US
Practice Address - Phone:570-587-1355
Practice Address - Fax:570-587-1355
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP004541B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily