Healthcare Provider Details

I. General information

NPI: 1275909335
Provider Name (Legal Business Name): KATHRYN LEIGH CARMICHAEL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN HEIBEL

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 BRIGHTWATERS DR
COCOA BEACH FL
32931-3818
US

IV. Provider business mailing address

362 BRIGHTWATERS DR
COCOA BEACH FL
32931-3818
US

V. Phone/Fax

Practice location:
  • Phone: 321-591-4338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9280143
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: