Provider Demographics
NPI:1649425554
Name:BYRUM, CAROL S (ARNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:S
Last Name:BYRUM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2400 S MCCALL RD
Mailing Address - Street 2:STE C
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-5137
Mailing Address - Country:US
Mailing Address - Phone:941-473-2913
Mailing Address - Fax:941-473-9813
Practice Address - Street 1:2400 S MCCALL RD
Practice Address - Street 2:STE C
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-5137
Practice Address - Country:US
Practice Address - Phone:941-474-9314
Practice Address - Fax:941-473-9813
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL48871225700000X
FL552412363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist