Provider Demographics
NPI:1134198864
Name:MCCARREN, VICKI R (MD)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:R
Last Name:MCCARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8357 MAREVA LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-9560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8592 POTTER PARK DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5467
Practice Address - Country:US
Practice Address - Phone:941-921-6618
Practice Address - Fax:941-922-0556
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252695600Medicaid
A80222Medicare UPIN
FL32136UMedicare PIN