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General NPI Number Information
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NPI Number | 1861038044
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Entity Type | Individual
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Provider Name | MARA DAWNE CARSON AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/21/2019
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 508 S HABANA AVE STE 160
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City | TAMPA
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State | FL
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Zip | 33609-4190
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Country | US
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Telephone | 813-708-8346
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Fax |
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Provider Business Mailing Address
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Address Line | 26224 N TATUM BLVD STE 15A
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City | PHOENIX
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State | AZ
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Zip | 85050-7500
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Country | US
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Telephone | 480-663-9632
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Fax | 480-419-6782
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN259811
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 259985
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN259811
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 11035299
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License Number State | FL
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