Healthcare Provider Details

I. General information

NPI: 1700703725
Provider Name (Legal Business Name): CARLEE D BRANCH ATS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W STADIUM AVE
WEST LAFAYETTE IN
47907-2046
US

IV. Provider business mailing address

4935 NW STATE ROAD 270
BRISTOL FL
32321
US

V. Phone/Fax

Practice location:
  • Phone: 765-496-0502
  • Fax:
Mailing address:
  • Phone: 850-643-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: