Provider Demographics
NPI:1386828374
Name:FLODIN, CAREN RUTH (NP)
Entity Type:Individual
Prefix:
First Name:CAREN
Middle Name:RUTH
Last Name:FLODIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAREN
Other - Middle Name:RUTH
Other - Last Name:MEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1830 MESQUITE AVENUE
Mailing Address - Street 2:STE A
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5791
Mailing Address - Country:US
Mailing Address - Phone:928-855-8071
Mailing Address - Fax:928-855-6869
Practice Address - Street 1:1830 MESQUITE AVENUE
Practice Address - Street 2:STE A
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5791
Practice Address - Country:US
Practice Address - Phone:928-855-8071
Practice Address - Fax:928-855-6869
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1653363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ82314Medicare PIN
AZX31847Medicare UPIN