Healthcare Provider Details

I. General information

NPI: 1992965701
Provider Name (Legal Business Name): HEATHER L CARPENTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 W NEWBERRY RD STE 5
GAINESVILLE FL
32607-2824
US

IV. Provider business mailing address

4881 NW 8TH AVE STE 2
GAINESVILLE FL
32605-4582
US

V. Phone/Fax

Practice location:
  • Phone: 352-224-2200
  • Fax: 352-224-2476
Mailing address:
  • Phone: 352-224-2485
  • Fax: 352-224-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME119918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: