Healthcare Provider Details

I. General information

NPI: 1346535093
Provider Name (Legal Business Name): CAROLYN K. LAVENDER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 PASADENA AVE. SOUTH SUITE 400
ST. PETERSBURG FL
33707-4505
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD ATTN: CREDENTIAL DEPARTMENT
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 727-341-1316
  • Fax: 727-345-4000
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP1885892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: