Healthcare Provider Details

I. General information

NPI: 1134046550
Provider Name (Legal Business Name): NICOLE CARLSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 SUNSET POINT RD
CLEARWATER FL
33765-1024
US

IV. Provider business mailing address

1825 SUNSET POINT RD
CLEARWATER FL
33765-1024
US

V. Phone/Fax

Practice location:
  • Phone: 727-888-6523
  • Fax:
Mailing address:
  • Phone: 727-888-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: