MEDICARE: HEATHER CARRICOFFE MCCARTHY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS 9885	FL

General Provider Information

NPI Number	:	1972625218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER CARRICOFFE MCCARTHY DO

Provider Business Mailing Address
First Line	:	770 CLAUGHTON ISLAND DR
Second Line	:	APT 2115
City	:	MIAMI
State	:	FL
Zip	:	33131-2617
Country	:	US
Telephone Number	:	305-903-6165
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 COLLEGE AVE
Second Line	:	NSU UNIVERSITY CENTER SPORTS MEDICINE DEPT
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33314
Country	:	US
Telephone Number	:	954-262-5590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	06/17/2008

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