Provider Demographics
NPI:1366774499
Name:JAFFE, CAROLYN (DOM, LAC)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:JAFFE
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 WEDGE CT
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CTR
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5160
Mailing Address - Country:US
Mailing Address - Phone:813-633-5707
Mailing Address - Fax:813-633-5707
Practice Address - Street 1:2004 WEDGE CT
Practice Address - Street 2:
Practice Address - City:SUN CITY CTR
Practice Address - State:FL
Practice Address - Zip Code:33573-5160
Practice Address - Country:US
Practice Address - Phone:813-633-5707
Practice Address - Fax:813-633-5707
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2039171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist