Provider Demographics
NPI:1245235787
Name:RENEAU, CAROLYN M (CNM)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:RENEAU
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:13110 ELK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7182
Mailing Address - Country:US
Mailing Address - Phone:813-349-7568
Mailing Address - Fax:813-349-7561
Practice Address - Street 1:1729 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3016
Practice Address - Country:US
Practice Address - Phone:863-940-2908
Practice Address - Fax:863-940-4722
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP1867632367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034266100Medicaid
FLU6289YMedicare PIN