Healthcare Provider Details

I. General information

NPI: 1083555361
Provider Name (Legal Business Name): CARLY CAVINESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 TOWN CENTER DR APT 403
JUPITER FL
33458-5258
US

IV. Provider business mailing address

1200 TOWN CENTER DR APT 403
JUPITER FL
33458-5258
US

V. Phone/Fax

Practice location:
  • Phone: 205-901-1550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11045957
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: