Healthcare Provider Details

I. General information

NPI: 1154596526
Provider Name (Legal Business Name): VICKI JO CARRIER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HALF MOON CIR #A-1
HYPOLUXO FL
33462-5487
US

IV. Provider business mailing address

105 HALF MOON CIR #A-1
HYPOLUXO FL
33462-5487
US

V. Phone/Fax

Practice location:
  • Phone: 561-585-7106
  • Fax: 561-585-4982
Mailing address:
  • Phone: 561-585-7106
  • Fax: 561-585-4982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP1888442
License Number StateFL

VIII. Authorized Official

Name: MRS. VICKI JO CARRIER
Title or Position: NURSE PRACTITIONER
Credential: ARNP-BC
Phone: 561-585-7106