Healthcare Provider Details

I. General information

NPI: 1316994767
Provider Name (Legal Business Name): KORIE L CARLSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 CITRUS TOWER BLVD SUITE 106
CLERMONT FL
34711-2712
US

IV. Provider business mailing address

14828 PINE CONE TRL
CLERMONT FL
34711-7699
US

V. Phone/Fax

Practice location:
  • Phone: 352-224-3121
  • Fax:
Mailing address:
  • Phone: 352-243-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1078
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: