Provider Demographics
NPI:1396026654
Name:BARNHILL, CARISA NICOLE (DO)
Entity Type:Individual
Prefix:DR
First Name:CARISA
Middle Name:NICOLE
Last Name:BARNHILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3440 W DR MLK BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6223
Mailing Address - Country:US
Mailing Address - Phone:813-872-7737
Mailing Address - Fax:813-443-8120
Practice Address - Street 1:3440 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6214
Practice Address - Country:US
Practice Address - Phone:813-872-7737
Practice Address - Fax:813-443-8120
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011018218207R00000X
FLOS14168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018892700Medicaid
FLIT432ZMedicare PIN