Provider Demographics
NPI:1710513569
Name:JONES, CARLY MAY
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:MAY
Last Name:JONES
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 1:12301 LAKE UNDERHILL RD STE 215
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4511
Mailing Address - Country:US
Mailing Address - Phone:321-235-0692
Mailing Address - Fax:321-235-0694
Practice Address - Street 1:364 NORTHPOINTE CT UNIT 206
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5811
Practice Address - Country:US
Practice Address - Phone:850-525-7338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112966363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant