Healthcare Provider Details

I. General information

NPI: 1366708463
Provider Name (Legal Business Name): CAROLYN COOK AP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9655 S DIXIE HWY SUITE 204
PINECREST FL
33156-2813
US

IV. Provider business mailing address

9655 S DIXIE HWY SUITE 204
PINECREST FL
33156-2813
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-9711
  • Fax:
Mailing address:
  • Phone: 305-665-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP974
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA16840
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: