Healthcare Provider Details

I. General information

NPI: 1316210263
Provider Name (Legal Business Name): CARRIE ELIZABETH INGRAM RN, MSN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 E MARION AVE STE 139
PUNTA GORDA FL
33950-3863
US

IV. Provider business mailing address

713 E MARION AVE
PUNTA GORDA FL
33950-3872
US

V. Phone/Fax

Practice location:
  • Phone: 941-833-1750
  • Fax: 941-766-1511
Mailing address:
  • Phone: 941-833-1750
  • Fax: 941-763-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN 0000120242
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3007428
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9375076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: