Healthcare Provider Details

I. General information

NPI: 1407458417
Provider Name (Legal Business Name): CAROLYN MARIE ADEMSKI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 TOUCHTON RD E STE 150
JACKSONVILLE FL
32246-8299
US

IV. Provider business mailing address

914 ORANGE ISLE
FORT LAUDERDALE FL
33315-1670
US

V. Phone/Fax

Practice location:
  • Phone: 415-671-2165
  • Fax:
Mailing address:
  • Phone: 302-650-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11003140
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberLP0000326
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11003140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: