Healthcare Provider Details

I. General information

NPI: 1649636945
Provider Name (Legal Business Name): DANA CARROLL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BENMORE DR STE 200
WINTER PARK FL
32792-4111
US

IV. Provider business mailing address

PO BOX 576
TAVARES FL
32778-0576
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-7070
  • Fax: 407-646-7747
Mailing address:
  • Phone: 352-978-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3409322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: