Provider Demographics
NPI:1760590731
Name:CARLSON, GAIL ANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:ANN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:KLEINSMITH
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:4880 N HIGHWAY 19A
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2018
Mailing Address - Country:US
Mailing Address - Phone:352-589-8111
Mailing Address - Fax:352-589-8495
Practice Address - Street 1:4880 N HIGHWAY 19A
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2018
Practice Address - Country:US
Practice Address - Phone:352-589-8111
Practice Address - Fax:352-589-8495
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2510532363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics