Provider Demographics
NPI:1821186081
Name:CAROLINA SHORES HEALTHCARE, LLC
Entity Type:Organization
Organization Name:CAROLINA SHORES HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:S
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:910-575-0281
Mailing Address - Street 1:9869 OCEAN HWY W STE 10
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-2636
Mailing Address - Country:US
Mailing Address - Phone:910-575-0281
Mailing Address - Fax:910-575-0282
Practice Address - Street 1:9869 OCEAN HWY W STE 10
Practice Address - Street 2:
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467-2636
Practice Address - Country:US
Practice Address - Phone:910-575-0281
Practice Address - Fax:910-575-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20979208D00000X
NC201481363LF0000X
NC005002515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900156Medicaid
NC2345392Medicare ID - Type Unspecified