Provider Demographics
NPI:1780984393
Name:CARMICHAEL, CAROLINA ALEXANDRIA (PA)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:ALEXANDRIA
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 VILLAGE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5419
Mailing Address - Country:US
Mailing Address - Phone:210-297-2244
Mailing Address - Fax:210-337-2644
Practice Address - Street 1:16977 INTERSTATE 35 N STE 210
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1466
Practice Address - Country:US
Practice Address - Phone:210-656-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMP363AM0700X
TXPA06889363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical