Provider Demographics
NPI:1164633087
Name:PHILLIPS, CARRI L (ARNP)
Entity Type:Individual
Prefix:
First Name:CARRI
Middle Name:L
Last Name:PHILLIPS
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 1:4951 GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8965
Mailing Address - Country:US
Mailing Address - Phone:850-473-0100
Mailing Address - Fax:850-473-0500
Practice Address - Street 1:5834 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-8275
Practice Address - Country:US
Practice Address - Phone:850-623-5437
Practice Address - Fax:850-626-7803
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1326922363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104809500Medicaid
FLARNP 1326922OtherSTATE LICENSE