Provider Demographics
NPI:1891774642
Name:LIEBERMAN, CAROL B (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:B
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 S. OCEAN DRIVE
Mailing Address - Street 2:APT 1001
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019
Mailing Address - Country:US
Mailing Address - Phone:305-968-4474
Mailing Address - Fax:
Practice Address - Street 1:2201 S OCEAN DR
Practice Address - Street 2:1001
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-2539
Practice Address - Country:US
Practice Address - Phone:305-968-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1185222363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6819OtherBCBS
FL302207200Medicaid
S48880Medicare UPIN
FL302207200Medicaid
FLY6819Medicare ID - Type Unspecified
FLY6819VMedicare ID - Type Unspecified