Healthcare Provider Details

I. General information

NPI: 1770479131
Provider Name (Legal Business Name): MASON DOUGLAS CARNLEY APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E HIGHWAY 20
NICEVILLE FL
32578-8826
US

IV. Provider business mailing address

2001 E HIGHWAY 20
NICEVILLE FL
32578-8826
US

V. Phone/Fax

Practice location:
  • Phone: 850-897-4400
  • Fax: 850-897-0623
Mailing address:
  • Phone: 850-897-4400
  • Fax: 850-897-0623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11040161
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: