Provider Demographics
NPI:1336330240
Name:BATES, CAROL ANN (AP DOM LICACU)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:BATES
Suffix:
Gender:F
Credentials:AP DOM LICACU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 EASTLAND BLVD
Mailing Address - Street 2:SUITE 105-H
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4106
Mailing Address - Country:US
Mailing Address - Phone:727-724-0488
Mailing Address - Fax:727-724-0489
Practice Address - Street 1:3023 EASTLAND BLVD
Practice Address - Street 2:SUITE 105-H
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4106
Practice Address - Country:US
Practice Address - Phone:727-724-0488
Practice Address - Fax:727-724-0489
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP000344171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist