Basic Information
| Provider Information | |||||||||
| NPI: | 1972625218 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCARTHY | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | CARRICOFFE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CARRICOFFE | ||||||||
| OtherFirstName: | HEATHER | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 770 CLAUGHTON ISLAND DR | ||||||||
| Address2: | APT 2115 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331312617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059036165 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3301 COLLEGE AVE | ||||||||
| Address2: | NSU UNIVERSITY CENTER SPORTS MEDICINE DEPT | ||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542625590 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 06/17/2008 | ||||||||
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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 | 207Q00000X | OS 9885 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.