Provider Demographics
NPI:1528016680
Name:CARLSON, NANCY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ANN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:CARLSON
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10201 ARCOS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-9460
Mailing Address - Country:US
Mailing Address - Phone:239-399-8019
Mailing Address - Fax:239-984-8965
Practice Address - Street 1:10201 ARCOS AVE STE 103
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-9460
Practice Address - Country:US
Practice Address - Phone:239-399-8019
Practice Address - Fax:239-984-8965
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420008079207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1003045Medicaid
F00329Medicare UPIN
VT1003045Medicaid