Provider Demographics
NPI:1851908677
Name:MACIAS, CAROLYN J (MSN APRN FNP BC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:MACIAS
Suffix:
Gender:F
Credentials:MSN APRN FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11322 SE 55TH AVENUE RD UNIT 901
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-3749
Mailing Address - Country:US
Mailing Address - Phone:352-653-8248
Mailing Address - Fax:
Practice Address - Street 1:11322 SE 55TH AVENUE RD UNIT 901
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3749
Practice Address - Country:US
Practice Address - Phone:352-653-8248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily