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NPI Code Detail

MEDICARE: CAROLYN THERESE LEPAGE ARNP-BC

MEDICARE: CAROLYN THERESE LEPAGE ARNP-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
1363LF0000XFamily Nurse PractitionerARNP1767012FL

General Provider Information

NPI Number : 1942206743
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN THERESE LEPAGE ARNP-BC
Provider Business Mailing Address
First Line : 1655 N 50TH AVE
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33021-4009
Country : US
Telephone Number : 954-682-4740
Fax Number : 954-894-6915
Provider Business Practice Location Address
First Line : 11300 NE 2ND AVE
Second Line :
City : MIAMI SHORES
State : FL
Zip : 33161-6628
Country : US
Telephone Number : 305-899-3800
Fax Number : 305-899-3831
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 07/08/2007

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