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General NPI Number Information
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NPI Number | 1972565547
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Entity Type | Individual
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Provider Name | CAROL JEANETTE FAIRCHILD ARNP
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Gender | Female
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 2020 COMMERCE DR
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City | MELBOURNE
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State | FL
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Zip | 32904-2335
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Country | US
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Telephone | 321-952-6000
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Fax | 321-637-3648
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Provider Business Mailing Address
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Address Line | 400 EAST SHERIDAN RD
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City | MELBOURNE
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State | FL
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Zip | 32901-3122
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Country | US
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Telephone | 321-722-5200
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Fax | 321-637-3648
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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 | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | ARNP2992062
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ARNP2992062
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License Number State | FL
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