Provider Demographics
NPI:1629827324
Name:CARR, CAROLINE ELISABETH (RDN/LDN)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:ELISABETH
Last Name:CARR
Suffix:
Gender:F
Credentials:RDN/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 ROCKPOND MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-5574
Mailing Address - Country:US
Mailing Address - Phone:904-699-8970
Mailing Address - Fax:
Practice Address - Street 1:836 PRUDENTIAL DR STE 1006
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8337
Practice Address - Country:US
Practice Address - Phone:904-202-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11833133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered