Provider Demographics
NPI:1205681087
Name:GREGG, CAROL (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:GREGG
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 1:4228 73RD TER E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-5112
Mailing Address - Country:US
Mailing Address - Phone:307-413-3113
Mailing Address - Fax:
Practice Address - Street 1:4228 73RD TER E
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-5112
Practice Address - Country:US
Practice Address - Phone:307-413-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9625381163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant