Basic Information
| Provider Information | |||||||||
| NPI: | 1649425554 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BYRUM | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | A.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 S MCCALL RD | ||||||||
| Address2: | STE C | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342245137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414732913 | ||||||||
| FaxNumber: | 9414739813 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 S MCCALL RD | ||||||||
| Address2: | STE C | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342245137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414749314 | ||||||||
| FaxNumber: | 9414739813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2008 | ||||||||
| LastUpdateDate: | 12/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 48871 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 363L00000X | 552412 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.