Healthcare Provider Details

I. General information

NPI: 1740897586
Provider Name (Legal Business Name): CARRIE ELIZABETH SKAGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 CYPRESS GROVE DR
EUSTIS FL
32736-2503
US

IV. Provider business mailing address

871 GALLOWAY ST
LAKE ALFRED FL
33850-3901
US

V. Phone/Fax

Practice location:
  • Phone: 407-907-2077
  • Fax:
Mailing address:
  • Phone: 815-979-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: