Provider Demographics
NPI:1881922730
Name:GRAVES, CARRIE J (DOM, AP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:J
Last Name:GRAVES
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ELIZABETH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DOM, AP
Mailing Address - Street 1:28467 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4333
Mailing Address - Country:US
Mailing Address - Phone:727-216-6929
Mailing Address - Fax:
Practice Address - Street 1:28467 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 302
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4333
Practice Address - Country:US
Practice Address - Phone:727-216-6929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171100000X
TXAC01241171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist