Provider Demographics
NPI:1457761058
Name:HALL, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8503 NW MARTIN L KING RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-2607
Mailing Address - Country:US
Mailing Address - Phone:850-643-6069
Mailing Address - Fax:
Practice Address - Street 1:8503 NW MARTIN L KING RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-2607
Practice Address - Country:US
Practice Address - Phone:850-643-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator