Provider Demographics
NPI:1093815151
Name:PAPPAS, CARRIE JO (CNP,MSN,RN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:JO
Last Name:PAPPAS
Suffix:
Gender:F
Credentials:CNP,MSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 WEBBER ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-4755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10150 HIGHLAND MANOR DR STE 240
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-9750
Practice Address - Country:US
Practice Address - Phone:813-259-1013
Practice Address - Fax:813-254-0396
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.08393-NP363L00000X
MI4704252316363L00000X
FL9400287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner