Provider Demographics
NPI:1972592962
Name:PHILLIPS, CARSWELLA ODESSA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CARSWELLA
Middle Name:ODESSA
Last Name:PHILLIPS
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 1:2928 NEPAL DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-2218
Mailing Address - Country:US
Mailing Address - Phone:850-933-0128
Mailing Address - Fax:
Practice Address - Street 1:116 FOOTE
Practice Address - Street 2:HILYER ADMINISTRATION CENTER
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32307
Practice Address - Country:US
Practice Address - Phone:850-599-3777
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9185394363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health