Healthcare Provider Details

I. General information

NPI: 1962498667
Provider Name (Legal Business Name): CAROL A JARZYN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 SE BALBOA AVE
STUART FL
34994-2327
US

IV. Provider business mailing address

1950 SW PALM CITY RD #8204
STUART FL
34994-4268
US

V. Phone/Fax

Practice location:
  • Phone: 772-463-4128
  • Fax: 772-463-4129
Mailing address:
  • Phone: 772-287-9171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 1122462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: