Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN11009655 | FL |
NPI | 1013525294 |
---|---|
Provider Name | Eric A Carlon |
First Address | Orlando, FL 32828-7365 |
Second Address | Orlando, FL 32828-4511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2020 |
Last Update Date | 22/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APRN11009655 | MEDICAL LICENSE (01) |