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General NPI Number Information
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NPI Number | 1437697646
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Entity Type | Organization
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Legal Business Name | JENS CHRISTIAN CARLSEN DO PLLC
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Dates
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Enumeration Date | 02/08/2017
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 2525 HARBOR BLVD STE. 301
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5317
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Country | US
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Telephone | 863-448-6019
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 HARBOR BLVD STE. 301
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5317
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Country | US
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Telephone | 863-448-6019
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | JENS CARLSEN
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Credential | DO
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Telephone | 863-448-6019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | OS10946
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License Number State | FL
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