Provider Demographics
NPI:1922023761
Name:BANKER, CAROL J (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:BANKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:PEDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2513 W KANSAS AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6297
Mailing Address - Country:US
Mailing Address - Phone:715-573-6551
Mailing Address - Fax:
Practice Address - Street 1:4700 N HABANA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7160
Practice Address - Country:US
Practice Address - Phone:813-348-0224
Practice Address - Fax:813-872-6792
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9252002363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIS71616Medicare UPIN
WI005539315Medicare ID - Type Unspecified