Provider Demographics
NPI:1346578549
Name:POLINS, CARLA JO (AP, DOM)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:JO
Last Name:POLINS
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:MISS
Other - First Name:CARLA
Other - Middle Name:JO
Other - Last Name:NACCARATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3231 GULF GATE DRIVE
Mailing Address - Street 2:SUITE #202
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231
Mailing Address - Country:US
Mailing Address - Phone:941-586-5362
Mailing Address - Fax:941-927-5056
Practice Address - Street 1:3231 GULF GATE DRIVE
Practice Address - Street 2:SUITE #202
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231
Practice Address - Country:US
Practice Address - Phone:941-586-5362
Practice Address - Fax:941-927-5056
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-27
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP#1318171100000X
FLAP1318171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP1318OtherSTATE LICENSE