Provider Demographics
NPI:1376049213
Name:CARNEVALE, PHILIP AUSTIN (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:AUSTIN
Last Name:CARNEVALE
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 BOWDEN RD STE 3
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5907
Mailing Address - Country:US
Mailing Address - Phone:904-609-3349
Mailing Address - Fax:904-212-2227
Practice Address - Street 1:5105 BOWDEN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:352-870-4661
Practice Address - Fax:904-212-2227
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-31
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9333709363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101879200Medicaid