MEDICARE: MARA DAWNE CARSON AGACNP-BC

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
1	363LA2100X	Acute Care Nurse Practitioner	RN259811	ID
2	363LA2100X	Acute Care Nurse Practitioner	259985	AZ
3	363LG0600X	Gerontology Nurse Practitioner	RN259811	GA
4	363LA2100X	Acute Care Nurse Practitioner	11035299	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1861038044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARA DAWNE CARSON AGACNP-BC

Provider Business Mailing Address
First Line	:	26224 N TATUM BLVD STE 15A
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-7500
Country	:	US
Telephone Number	:	480-663-9632
Fax Number	:	480-419-6782

Provider Business Practice Location Address
First Line	:	508 S HABANA AVE STE 160
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4190
Country	:	US
Telephone Number	:	813-708-8346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	02/03/2025

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