Healthcare Provider Details

I. General information

NPI: 1336340934
Provider Name (Legal Business Name): CAROLYN M. CAREY, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 COLONIAL BLVD
FORT MYERS FL
33912-1017
US

IV. Provider business mailing address

601 5TH ST S SUITE 511
ST PETERSBURG FL
33701-4804
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-8181
  • Fax: 727-767-8030
Mailing address:
  • Phone: 727-767-8181
  • Fax: 727-767-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE HANCOCK
Title or Position: ADMINISTRATOR
Credential:
Phone: 727-767-3808