Provider Demographics
NPI:1023495991
Name:CARLISLE, SOFIA A
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:A
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SOFIA
Other - Middle Name:A
Other - Last Name:CARLISLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RT
Mailing Address - Street 1:1228 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8967
Mailing Address - Country:US
Mailing Address - Phone:904-589-8861
Mailing Address - Fax:
Practice Address - Street 1:1228 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-8967
Practice Address - Country:US
Practice Address - Phone:904-589-8861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT15442227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified