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NPI Code Detail

MEDICARE: CAROL P ENNIS APRN

MEDICARE: CAROL P ENNIS APRN
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
1363LF0000XFamily Nurse Practitioner11005062FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760027767
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL P ENNIS APRN
Provider Business Mailing Address
First Line : 10330 NUVISTA AVE
Second Line :
City : WELLINGTON
State : FL
Zip : 33414-9365
Country : US
Telephone Number : 561-445-4630
Fax Number :
Provider Business Practice Location Address
First Line : 10330 NUVISTA AVE
Second Line :
City : WELLINGTON
State : FL
Zip : 33414-9365
Country : US
Telephone Number : 561-598-5449
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2019
Last Update Date : 07/08/2022

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