Provider Demographics
NPI:1316210263
Name:INGRAM, CARRIE ELIZABETH (RN, MSN, APRN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:INGRAM
Suffix:
Gender:F
Credentials:RN, MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 E MARION AVE
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3872
Mailing Address - Country:US
Mailing Address - Phone:941-833-1750
Mailing Address - Fax:941-763-1511
Practice Address - Street 1:713 E MARION AVE STE 139
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3863
Practice Address - Country:US
Practice Address - Phone:941-833-1750
Practice Address - Fax:941-766-1511
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN 0000120242163WP0808X
KY3007428363LP0808X
FLARNP9375076363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK043781Medicare UPIN
KYK043782Medicare UPIN
KYK043780Medicare UPIN