Basic Information
| Provider Information | |||||||||
| NPI: | 1184148405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | E | ||||||||
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| NameSuffix: | II | ||||||||
| Credential: | CRT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6851 DISTRIBUTION AVE S | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322562742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043874481 | ||||||||
| FaxNumber: | 9043896965 | ||||||||
| Practice Location | |||||||||
| Address1: | 6851 DISTRIBUTION AVE. | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043874481 | ||||||||
| FaxNumber: | 9043896965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227800000X | TT14479 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified |
No ID Information.