Provider Demographics
NPI:1982649703
Name:STATON, CARRIE LYNN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LYNN
Last Name:STATON
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 1:10507 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-5047
Mailing Address - Country:US
Mailing Address - Phone:352-688-0401
Mailing Address - Fax:352-688-0404
Practice Address - Street 1:10507 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-5047
Practice Address - Country:US
Practice Address - Phone:352-688-0401
Practice Address - Fax:352-688-0404
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP861942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y011COtherBCBS
FL306357700Medicaid
FLP81946Medicare UPIN