Provider Demographics
NPI:1417983743
Name:GITTINGS, CARRIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:A
Last Name:GITTINGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 W OAK ST STE A
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-6624
Mailing Address - Country:US
Mailing Address - Phone:407-846-8600
Mailing Address - Fax:407-846-2301
Practice Address - Street 1:461 W OAK ST STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-6624
Practice Address - Country:US
Practice Address - Phone:407-846-8600
Practice Address - Fax:407-846-2301
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273472900Medicaid
FL75189YMedicare UPIN
FLI40386Medicare UPIN