Provider Demographics
NPI:1316902059
Name:EASTON, CAROL TAYLOR (ARNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:TAYLOR
Last Name:EASTON
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 1:1705 MAHAN DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5201
Mailing Address - Country:US
Mailing Address - Phone:850-877-7164
Mailing Address - Fax:850-877-1886
Practice Address - Street 1:1705 MAHAN DR.
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-877-7164
Practice Address - Fax:850-877-1886
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1577642163W00000X
FLBMO52400247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307773000Medicaid
FLEO244YMedicare PIN
FLS50205Medicare UPIN