Healthcare Provider Details

I. General information

NPI: 1841521002
Provider Name (Legal Business Name): MARIE MICHELLE CARNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 NW 35TH AVE
LAUDERDALE LAKES FL
33311-1107
US

IV. Provider business mailing address

9740 VINEYARD CT
BOCA RATON FL
33428-4347
US

V. Phone/Fax

Practice location:
  • Phone: 561-483-6266
  • Fax:
Mailing address:
  • Phone: 561-843-2325
  • Fax: 561-496-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9174534
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: