Provider Demographics
NPI:1972887164
Name:FAXAS, CAROLINE GOSSAGE (AP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:GOSSAGE
Last Name:FAXAS
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3336 OLD OAK LN
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8438
Mailing Address - Country:US
Mailing Address - Phone:954-243-9093
Mailing Address - Fax:954-333-3556
Practice Address - Street 1:103 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-3703
Practice Address - Country:US
Practice Address - Phone:561-455-2147
Practice Address - Fax:561-455-2762
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3023171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist