Provider Demographics
NPI:1346535093
Name:LAVENDER, CAROLYN K (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:K
Last Name:LAVENDER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN: CREDENTIAL DEPARTMENT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:1615 PASADENA AVE. SOUTH
Practice Address - Street 2:SUITE 400
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-4505
Practice Address - Country:US
Practice Address - Phone:727-341-1316
Practice Address - Fax:727-345-4000
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1885892363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner