Provider Demographics
NPI:1942267729
Name:SPIVEY, CAROL (ARNP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:SPIVEY
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 1:2433 MAHAN DR
Mailing Address - Street 2:DERMATOLOGY ADVANCED CARE
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5329
Mailing Address - Country:US
Mailing Address - Phone:850-219-8811
Mailing Address - Fax:850-219-8883
Practice Address - Street 1:2433 MAHAN DR
Practice Address - Street 2:DERMATOLOGY ADVANCED CARE
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5329
Practice Address - Country:US
Practice Address - Phone:850-219-8811
Practice Address - Fax:850-219-8883
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2158032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P59243Medicare UPIN