Provider Demographics
NPI:1295849347
Name:CANTWELL, CAROL L (CNM)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:L
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5741 BEE RIDGE RD
Mailing Address - Street 2:SUITE 390
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5064
Mailing Address - Country:US
Mailing Address - Phone:941-379-6331
Mailing Address - Fax:941-379-5642
Practice Address - Street 1:5741 BEE RIDGE RD
Practice Address - Street 2:SUITE 390
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5064
Practice Address - Country:US
Practice Address - Phone:941-379-6331
Practice Address - Fax:941-379-5642
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9227622176B00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered176B00000XOther Service ProvidersMidwife
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9227622OtherLICENSE