Provider Demographics
NPI:1427263599
Name:CARLSON, BRUCE WAYNE (AART)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:WAYNE
Last Name:CARLSON
Suffix:
Gender:M
Credentials:AART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5946 NW 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4268
Mailing Address - Country:US
Mailing Address - Phone:954-552-7252
Mailing Address - Fax:
Practice Address - Street 1:5946 NW 88TH AVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4268
Practice Address - Country:US
Practice Address - Phone:954-552-7252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT6075247200000X
WYGN130999247200000X
CARHT90772247200000X
NE3390247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other