Provider Demographics
NPI:1073583837
Name:CASE, CAROLYN MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MARIE
Last Name:CASE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 WHITE PLAINS RD STE 510
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5152
Mailing Address - Country:US
Mailing Address - Phone:914-345-5900
Mailing Address - Fax:
Practice Address - Street 1:5454 LENA RD
Practice Address - Street 2:SUITE 106
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9499
Practice Address - Country:US
Practice Address - Phone:941-900-1111
Practice Address - Fax:941-201-4856
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333935363LF0000X
NYF401127363LP0808X
FLARNP9276826363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1005233OtherCIGNA
FLBV349ZMedicare PIN