Provider Demographics
NPI:1437252434
Name:VAN ARNAM, CARLA SHA (LMT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:SHA
Last Name:VAN ARNAM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 SW 91ST TER
Mailing Address - Street 2:SUITE O-102
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-9109
Mailing Address - Country:US
Mailing Address - Phone:352-318-8974
Mailing Address - Fax:352-372-6549
Practice Address - Street 1:4833 SW 91ST TER
Practice Address - Street 2:SUITE O-102
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-9109
Practice Address - Country:US
Practice Address - Phone:352-372-6550
Practice Address - Fax:352-372-6549
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA41884225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2850OtherBLUE CROSS BLUE SHIELD FL