Provider Demographics
NPI:1669466306
Name:BECKER, CAROL LEA (CPNP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LEA
Last Name:BECKER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 WILMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1480
Mailing Address - Country:US
Mailing Address - Phone:402-880-9297
Mailing Address - Fax:
Practice Address - Street 1:1551 WILMINGTON DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1480
Practice Address - Country:US
Practice Address - Phone:402-880-9297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9296077363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics