Provider Demographics
NPI:1013107994
Name:LIVELLI, CAROL L (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:LIVELLI
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 1:14430 US HIGHWAY 1
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3289
Mailing Address - Country:US
Mailing Address - Phone:772-581-0478
Mailing Address - Fax:
Practice Address - Street 1:14430 US HIGHWAY 1
Practice Address - Street 2:SUITE 101
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3289
Practice Address - Country:US
Practice Address - Phone:772-581-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP18734363LP0200X
FLARNP9313619363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics