Healthcare Provider Details

I. General information

NPI: 1760928675
Provider Name (Legal Business Name): CAROLYN GAROFALO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN MILLER PA-C

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ARLINGTON ST SUITE 101
SARASOTA FL
34239-3507
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-3400
  • Fax: 941-917-4300
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: