Provider Demographics
NPI:1679267264
Name:O'DELL, CAROLYN (APRN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:O'DELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5132 MANDAVILLA BLVD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-8934
Mailing Address - Country:US
Mailing Address - Phone:931-237-9700
Mailing Address - Fax:
Practice Address - Street 1:5132 MANDAVILLA BLVD
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-8934
Practice Address - Country:US
Practice Address - Phone:931-237-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025010363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health