Healthcare Provider Details

I. General information

NPI: 1720596521
Provider Name (Legal Business Name): ROBERT CARR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 NIKKI VIEW DR
BRANDON FL
33511-4879
US

IV. Provider business mailing address

6421 CONGRESS AVE STE 113
BOCA RATON FL
33487-2858
US

V. Phone/Fax

Practice location:
  • Phone: 813-879-8045
  • Fax: 813-685-2477
Mailing address:
  • Phone: 813-571-7184
  • Fax: 813-654-4695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110966
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9110966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: