Provider Demographics
NPI:1164810610
Name:CARBONE, JARED JOSHUA (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:JOSHUA
Last Name:CARBONE
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:52 WILLOMERE WAY
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681
Mailing Address - Country:US
Mailing Address - Phone:864-979-8367
Mailing Address - Fax:877-935-4151
Practice Address - Street 1:1990 AUGUSTA ST STE 1300
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-6508
Practice Address - Country:US
Practice Address - Phone:864-477-3447
Practice Address - Fax:877-935-4151
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC92956163WP0808X
SC2255363LP0808X
SC22555363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health