Healthcare Provider Details

I. General information

NPI: 1013141514
Provider Name (Legal Business Name): ELIZABETH J CARPENTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 NOLAND DR
BRANDON FL
33511-5719
US

IV. Provider business mailing address

4620 N HABANA AVE STE 101
TAMPA FL
33614-7107
US

V. Phone/Fax

Practice location:
  • Phone: 813-333-1601
  • Fax:
Mailing address:
  • Phone: 813-875-9362
  • Fax: 813-876-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME119352
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME119352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: