Provider Demographics
NPI:1386995918
Name:CARL R. DARNELL ARMY MEDIAL CENTER
Entity type:Organization
Organization Name:CARL R. DARNELL ARMY MEDIAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DAC
Authorized Official - Phone:254-286-7323
Mailing Address - Street 1:2623 QUEEN ALBERTA DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6527
Mailing Address - Country:US
Mailing Address - Phone:813-315-8162
Mailing Address - Fax:
Practice Address - Street 1:2623 QUEEN ALBERTA DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6527
Practice Address - Country:US
Practice Address - Phone:813-315-8162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. ARMY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-22
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9226566251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9226566OtherARNP