Provider Demographics
NPI:1518936608
Name:CARR, MARILYN LEA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:LEA
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 1:4811 W SPRING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8215
Mailing Address - Country:US
Mailing Address - Phone:813-837-2354
Mailing Address - Fax:
Practice Address - Street 1:12420 130TH AVE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1950
Practice Address - Country:US
Practice Address - Phone:727-588-4040
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL910712363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics