Provider Demographics
NPI:1245985829
Name:CARL, KACIE BRICE (DNP, CRNA)
Entity type:Individual
Prefix:DR
First Name:KACIE
Middle Name:BRICE
Last Name:CARL
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:KACIE
Other - Middle Name:BRICE
Other - Last Name:GEFFON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:760 71ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-5812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:760 71ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5812
Practice Address - Country:US
Practice Address - Phone:727-409-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-13
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL138121367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered