Healthcare Provider Details

I. General information

NPI: 1184776833
Provider Name (Legal Business Name): CAROL ANN WELLS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

18613 NW 94TH AVE
ALACHUA FL
32615-6006
US

V. Phone/Fax

Practice location:
  • Phone: 352-264-7392
  • Fax:
Mailing address:
  • Phone: 386-462-4879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0050-01460
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1967302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: