Healthcare Provider Details

I. General information

NPI: 1154576411
Provider Name (Legal Business Name): CARLA SAKOSKY SHULMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2008
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 S SUN DR STE 1043
LAKE MARY FL
32746-2573
US

IV. Provider business mailing address

1071 S SUN DR STE 1043
LAKE MARY FL
32746-2573
US

V. Phone/Fax

Practice location:
  • Phone: 407-333-1616
  • Fax: 407-333-1617
Mailing address:
  • Phone: 407-333-1616
  • Fax: 407-333-1617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP1104132
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN1104132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: