Healthcare Provider Details

I. General information

NPI: 1467856930
Provider Name (Legal Business Name): CARRIE ELLIOTT HOSHOUR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 BROAD ST SUITE 100
SUMTER SC
29150-4167
US

IV. Provider business mailing address

325 BROAD ST STE 100
SUMTER SC
29150-4167
US

V. Phone/Fax

Practice location:
  • Phone: 803-773-5227
  • Fax: 803-753-9312
Mailing address:
  • Phone: 803-773-5227
  • Fax: 803-753-9312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF1014216
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19164
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: