Provider Demographics
NPI:1326390683
Name:PROUX, CARLINE ELIZABETH (NA)
Entity Type:Individual
Prefix:MRS
First Name:CARLINE
Middle Name:ELIZABETH
Last Name:PROUX
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 HUNGARY RD
Mailing Address - Street 2:4055 TAMIAMI TRL SUITE 15
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34288-8744
Mailing Address - Country:US
Mailing Address - Phone:941-412-7530
Mailing Address - Fax:800-403-7521
Practice Address - Street 1:4929 HUNGARY RD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34288-8744
Practice Address - Country:US
Practice Address - Phone:941-412-7530
Practice Address - Fax:800-403-7521
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372600000X
FL232051251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty