Provider Demographics
NPI:1750649885
Name:CARLSON, ANDREW CLIFFORD II (CNMT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:CLIFFORD
Last Name:CARLSON
Suffix:II
Gender:M
Credentials:CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VIA ROYALE APT 2004
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7084
Mailing Address - Country:US
Mailing Address - Phone:561-401-9884
Mailing Address - Fax:
Practice Address - Street 1:2000 VIA ROYALE APT 2004
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7084
Practice Address - Country:US
Practice Address - Phone:561-401-9884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT321942471N0900X, 247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology