Provider Demographics
NPI:1013742642
Name:CARLSON, CARIANN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:CARIANN
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876 TURTLE SHORES DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-6642
Mailing Address - Country:US
Mailing Address - Phone:425-698-9570
Mailing Address - Fax:
Practice Address - Street 1:2876 TURTLE SHORES DR
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-6642
Practice Address - Country:US
Practice Address - Phone:425-698-9570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9581393163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty