Provider Demographics
NPI:1437697646
Name:JENS CHRISTIAN CARLSEN DO PLLC
Entity Type:Organization
Organization Name:JENS CHRISTIAN CARLSEN DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:863-448-6019
Mailing Address - Street 1:2525 HARBOR BLVD
Mailing Address - Street 2:STE. 301
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5317
Mailing Address - Country:US
Mailing Address - Phone:863-448-6019
Mailing Address - Fax:
Practice Address - Street 1:2525 HARBOR BLVD
Practice Address - Street 2:STE. 301
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5317
Practice Address - Country:US
Practice Address - Phone:863-448-6019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10946208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty