Healthcare Provider Details

I. General information

NPI: 1760011092
Provider Name (Legal Business Name): KATHERINE CARSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13933 17TH ST STE 200
DADE CITY FL
33525-4604
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 235
ORLANDO FL
32804-4659
US

V. Phone/Fax

Practice location:
  • Phone: 352-437-5972
  • Fax: 352-437-5974
Mailing address:
  • Phone: 407-303-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME154387
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: