Provider Demographics
NPI:1518108844
Name:PRATHER, CARRIE JO (DO)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:JO
Last Name:PRATHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:688 VERONA CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3544
Mailing Address - Country:US
Mailing Address - Phone:615-371-5744
Mailing Address - Fax:615-246-3939
Practice Address - Street 1:2776 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5864
Practice Address - Country:US
Practice Address - Phone:239-343-2837
Practice Address - Fax:239-343-3164
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11243208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine