Healthcare Provider Details

I. General information

NPI: 1366413692
Provider Name (Legal Business Name): CAROL ANNE LAVIN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 WEST MAIN STREET LEVY COUNTY HEALTH DEPARTMENT
BRONSON FL
32621
US

IV. Provider business mailing address

PO BOX 69
OLD TOWN FL
32680-0069
US

V. Phone/Fax

Practice location:
  • Phone: 352-486-5300
  • Fax: 352-486-5370
Mailing address:
  • Phone: 352-542-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 495102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: