Healthcare Provider Details

I. General information

NPI: 1164633087
Provider Name (Legal Business Name): CARRI L PHILLIPS A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5834 BERRYHILL RD
MILTON FL
32570-8275
US

IV. Provider business mailing address

4951 GRANDE DR
PENSACOLA FL
32504-8965
US

V. Phone/Fax

Practice location:
  • Phone: 850-623-5437
  • Fax: 850-626-7803
Mailing address:
  • Phone: 850-473-0100
  • Fax: 850-473-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP 1326922
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: