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General NPI Number Information
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NPI Number | 1922178706
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Entity Type | Individual
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Provider Name | CAROL L TAKIS PA C
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 1135 LAKE AVE
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City | CLERMONT
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State | FL
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Zip | 34711
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Country | US
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Telephone | 352-394-4035
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Fax | 352-241-0896
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Provider Business Mailing Address
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Address Line | PO BOX 121009
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City | CLERMONT
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State | FL
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Zip | 34712
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Country | US
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Telephone | 352-394-4035
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Fax | 352-241-0896
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA9103292
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9103292
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License Number State | FL
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