Provider Demographics
NPI:1497314124
Name:AUSTIN, CAROL (APRN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 NE 17TH TER
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-5425
Mailing Address - Country:US
Mailing Address - Phone:954-401-4397
Mailing Address - Fax:
Practice Address - Street 1:4675 LINTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6615
Practice Address - Country:US
Practice Address - Phone:561-331-5050
Practice Address - Fax:561-331-3711
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002721363L00000X, 363LF0000X
FL9352445363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11002721OtherMEDICAL LICENSE
FL14502950OtherCAQH