Provider Demographics
NPI:1487315545
Name:CARR, SUE ANNE
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ANNE
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SUE
Other - Middle Name:ANNE
Other - Last Name:LACASSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2806 WITLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1325
Mailing Address - Country:US
Mailing Address - Phone:727-647-0818
Mailing Address - Fax:
Practice Address - Street 1:4550 VILLAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-1224
Practice Address - Country:US
Practice Address - Phone:727-772-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator