Healthcare Provider Details

I. General information

NPI: 1073577938
Provider Name (Legal Business Name): JOANNE L CARLSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNE CARLSON KURTZ

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST UFJP PEDIATRIC DEPT.
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

PO BOX 191 PROVIDER ENROLLMENT DEPT
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-3050
  • Fax:
Mailing address:
  • Phone: 302-651-6212
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number224192
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME97112
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME97112
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME98112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: