Provider Demographics
NPI:1912502030
Name:CARLSGAARD, PRISCILLA (MS)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:CARLSGAARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 TALBOT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-5312
Mailing Address - Country:US
Mailing Address - Phone:561-339-4293
Mailing Address - Fax:
Practice Address - Street 1:10175 FORTUNE PKWY UNIT 902
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6755
Practice Address - Country:US
Practice Address - Phone:904-420-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3432106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist