Provider Demographics
NPI:1518210970
Name:CARR, ADA MARIA (ARNP)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:MARIA
Last Name:CARR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 W NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3705
Mailing Address - Country:US
Mailing Address - Phone:321-622-8626
Mailing Address - Fax:321-622-8627
Practice Address - Street 1:3044 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3566
Practice Address - Country:US
Practice Address - Phone:321-622-8626
Practice Address - Fax:321-622-8627
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9342368363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health