Provider Demographics
NPI:1962473389
Name:DICARLO, CARLTON ANTHONY (PA)
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:ANTHONY
Last Name:DICARLO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 ZEAGLER DRIVE
Mailing Address - Street 2:BLDG 101
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177
Mailing Address - Country:US
Mailing Address - Phone:386-328-6746
Mailing Address - Fax:386-328-7554
Practice Address - Street 1:205 ZEAGLER DRIVE
Practice Address - Street 2:BLDG 101
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177
Practice Address - Country:US
Practice Address - Phone:386-328-6746
Practice Address - Fax:386-328-7554
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA2025363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant