Provider Demographics
NPI:1518053537
Name:MCLANE, CAROLE (DO)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:MCLANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19320 GREEN VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-6632
Mailing Address - Country:US
Mailing Address - Phone:352-213-5676
Mailing Address - Fax:
Practice Address - Street 1:7035 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1203
Practice Address - Country:US
Practice Address - Phone:727-345-6337
Practice Address - Fax:727-347-0403
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58120OtherBCBS FL