Provider Demographics
NPI:1639445000
Name:WALKER, CARLA M (CNA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5422 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-1334
Mailing Address - Country:US
Mailing Address - Phone:904-405-8171
Mailing Address - Fax:
Practice Address - Street 1:5422 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-1334
Practice Address - Country:US
Practice Address - Phone:904-405-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL115181376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide