Provider Demographics
NPI:1427479765
Name:CARTY, AUDREY
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:CARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N ORANGE BLOSSOM TRL
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-2306
Mailing Address - Country:US
Mailing Address - Phone:407-944-3024
Mailing Address - Fax:407-944-3046
Practice Address - Street 1:2400 N ORANGE BLOSSOM TRL
Practice Address - Street 2:SUITE 301
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2306
Practice Address - Country:US
Practice Address - Phone:407-944-3024
Practice Address - Fax:407-944-3046
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9193272363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology