Provider Demographics
NPI:1457516478
Name:CIMARRON, CAROLE DARCEY (RN, LMT)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:DARCEY
Last Name:CIMARRON
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3857 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-4025
Mailing Address - Country:US
Mailing Address - Phone:352-317-1027
Mailing Address - Fax:
Practice Address - Street 1:2016 DELTA BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4897
Practice Address - Country:US
Practice Address - Phone:850-878-4434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA17933174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist