Provider Demographics
NPI:1063416865
Name:MCCREARY, CARRIE REEVES (NP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:REEVES
Last Name:MCCREARY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7021
Mailing Address - Country:US
Mailing Address - Phone:561-622-6111
Mailing Address - Fax:855-215-9930
Practice Address - Street 1:900 SE SALERNO RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6405
Practice Address - Country:US
Practice Address - Phone:772-223-7851
Practice Address - Fax:772-223-7851
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN129010163W00000X, 363L00000X
FLARNP9340627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC16144Medicare UPIN
TN3909501Medicare ID - Type Unspecified