Provider Demographics
NPI:1265994107
Name:CARMICHAEL, JUSTINE BRITTANY (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:BRITTANY
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:911 PAINTED PONY LN
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-9394
Mailing Address - Country:US
Mailing Address - Phone:575-308-9992
Mailing Address - Fax:
Practice Address - Street 1:1034 N SPRING ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5150
Practice Address - Country:US
Practice Address - Phone:575-941-3854
Practice Address - Fax:575-941-3592
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM55706363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner