Healthcare Provider Details

I. General information

NPI: 1083807465
Provider Name (Legal Business Name): CARRIE ELIZABETH NEWSOME RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 O/S HWY STANLEY SWITLIK ELEMENTARY SCHOOL
MARATHON FL
33050
US

IV. Provider business mailing address

203 CAMINO REAL
MARATHON FL
33050-2474
US

V. Phone/Fax

Practice location:
  • Phone: 305-289-2490
  • Fax: 305-289-2496
Mailing address:
  • Phone: 267-987-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9209676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: