Basic Information
| Provider Information | |||||||||
| NPI: | 1992208755 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHWARZ | ||||||||
| FirstName: | CARLYN | ||||||||
| MiddleName: | MICHEL | ||||||||
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| Credential: | FNP - C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 SIGMA DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | SUMMERVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294867722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436956071 | ||||||||
| FaxNumber: | 8435695879 | ||||||||
| Practice Location | |||||||||
| Address1: | 776 DANIEL ELLIS DR STE 1B | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294123095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437950300 | ||||||||
| FaxNumber: | 8434066010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2018 | ||||||||
| LastUpdateDate: | 02/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 21751 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | NP5085 | 05 | SC | MEDICAID |