Provider Demographics
NPI:1366413692
Name:LAVIN, CAROL ANNE (ARNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:LAVIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32680-0069
Mailing Address - Country:US
Mailing Address - Phone:352-542-8014
Mailing Address - Fax:
Practice Address - Street 1:66 WEST MAIN STREET
Practice Address - Street 2:LEVY COUNTY HEALTH DEPARTMENT
Practice Address - City:BRONSON
Practice Address - State:FL
Practice Address - Zip Code:32621
Practice Address - Country:US
Practice Address - Phone:352-486-5300
Practice Address - Fax:352-486-5370
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 495102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 495102OtherNURSING LICENSE FOR STATE
FLARNP 495102OtherNURSING LICENSE FOR STATE
FLR88088Medicare UPIN