Provider Demographics
NPI:1932241353
Name:LAWRENCE, CAROLINE P (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:P
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1167
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:FL
Mailing Address - Zip Code:32538-1167
Mailing Address - Country:US
Mailing Address - Phone:850-892-2888
Mailing Address - Fax:
Practice Address - Street 1:21 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-2529
Practice Address - Country:US
Practice Address - Phone:850-892-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAX2663363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical