Provider Demographics
NPI:1679558795
Name:FLETCHER, CARIE A (DO)
Entity Type:Individual
Prefix:DR
First Name:CARIE
Middle Name:A
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 N DAVIS HWY
Mailing Address - Street 2:STE C-1
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2720
Mailing Address - Country:US
Mailing Address - Phone:850-477-3252
Mailing Address - Fax:850-477-2659
Practice Address - Street 1:4511 N DAVIS HWY
Practice Address - Street 2:STE C-1
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2720
Practice Address - Country:US
Practice Address - Phone:850-477-3252
Practice Address - Fax:850-477-2659
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273584900Medicaid
FLK0750Medicare UPIN
FLFK431XMedicare PIN