Provider Demographics
NPI:1396955365
Name:PLESCOVICH, CAROL LYNNE (RN)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNNE
Last Name:PLESCOVICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:LYNNE
Other - Last Name:SELBST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:654 NW 107TH LN
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7943
Mailing Address - Country:US
Mailing Address - Phone:954-341-6444
Mailing Address - Fax:
Practice Address - Street 1:3275 NW 99TH WAY
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4024
Practice Address - Country:US
Practice Address - Phone:954-341-3925
Practice Address - Fax:954-341-3919
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2205152163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)