Healthcare Provider Details

I. General information

NPI: 1649425554
Provider Name (Legal Business Name): CAROL S BYRUM A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S MCCALL RD STE C
ENGLEWOOD FL
34224-5137
US

IV. Provider business mailing address

2400 S MCCALL RD STE C
ENGLEWOOD FL
34224-5137
US

V. Phone/Fax

Practice location:
  • Phone: 941-474-9314
  • Fax: 941-473-9813
Mailing address:
  • Phone: 941-473-2913
  • Fax: 941-473-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number552412
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number48871
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: