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NPI Code Detail

MEDICARE: JACQUELINE CARLSON NP

MEDICARE: JACQUELINE CARLSON NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner11019665FL

General Provider Information

NPI Number : 1730826538
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE CARLSON NP
Provider Business Mailing Address
First Line : 23043 OLEAN BLVD
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33952-7120
Country : US
Telephone Number : 941-661-6199
Fax Number :
Provider Business Practice Location Address
First Line : 8570 GRANITE CT STE 101
Second Line :
City : FORT MYERS
State : FL
Zip : 33908-4240
Country : US
Telephone Number : 833-769-3524
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2022
Last Update Date : 08/23/2024

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