Provider Demographics
NPI:1740766641
Name:CARPENTER, HALEY ELIZABETH MARIE (MD, PHD)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:ELIZABETH MARIE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 N UNIVERSITY DR STE 400
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-1408
Mailing Address - Country:US
Mailing Address - Phone:904-861-4153
Mailing Address - Fax:
Practice Address - Street 1:2855 N UNIVERSITY DR STE 400
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-1408
Practice Address - Country:US
Practice Address - Phone:561-235-0942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1649292086S0122X, 2086S0122X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1740766641Medicaid