Provider Demographics
NPI:1316551823
Name:COOKSEY, CARLIE (NP)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:
Last Name:COOKSEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 NW 13TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2269
Mailing Address - Country:US
Mailing Address - Phone:561-955-6663
Mailing Address - Fax:561-955-2879
Practice Address - Street 1:7301A W PALMETTO PARK RD STE 100B
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3403
Practice Address - Country:US
Practice Address - Phone:561-955-5761
Practice Address - Fax:561-955-6269
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012514363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily