Healthcare Provider Details

I. General information

NPI: 1053624221
Provider Name (Legal Business Name): ELIZABETH D CARSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH CARSON WEINSTEIN M.D.

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 LITTLE RD
TRINITY FL
34655-1743
US

IV. Provider business mailing address

4111 LITTLE RD
TRINITY FL
34655-1743
US

V. Phone/Fax

Practice location:
  • Phone: 727-938-1908
  • Fax:
Mailing address:
  • Phone: 727-947-9995
  • Fax: 727-938-8693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME108731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: