Provider Demographics
NPI:1154345767
Name:KALIVODA, CAROLE A (ARNP)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:A
Last Name:KALIVODA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 W NEWBERRY RD
Mailing Address - Street 2:SUITE 409
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4381
Mailing Address - Country:US
Mailing Address - Phone:352-333-6161
Mailing Address - Fax:352-333-6162
Practice Address - Street 1:6440 W NEWBERRY RD
Practice Address - Street 2:SUITE 409
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4381
Practice Address - Country:US
Practice Address - Phone:352-333-6161
Practice Address - Fax:352-333-6162
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 913452363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015670200Medicaid
FLP00406423OtherMEDICARE RAILROAD
FLP00406423OtherMEDICARE RAILROAD
FLE0789UMedicare PIN
FLEO789RMedicare PIN