Provider Demographics
NPI:1598358269
Name:CARSON, MICHAELA BROOKE
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:BROOKE
Last Name:CARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 GULFWINDS DR W
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1315
Mailing Address - Country:US
Mailing Address - Phone:727-946-3662
Mailing Address - Fax:
Practice Address - Street 1:97 GULFWINDS DR W
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1315
Practice Address - Country:US
Practice Address - Phone:727-946-3662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program