Provider Demographics
NPI:1861459117
Name:INMAN, CAROLYN L (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:L
Last Name:INMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10051 5TH ST N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:
Practice Address - Street 1:787 CORTARO DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6812
Practice Address - Country:US
Practice Address - Phone:813-634-2500
Practice Address - Fax:813-634-3008
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC22347207Q00000X
FLME126749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH62103Medicare UPIN