Provider Demographics
NPI:1699318865
Name:ROUNTREE, CARL THOMAS II (APRN, FNP-BC)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:THOMAS
Last Name:ROUNTREE
Suffix:II
Gender:M
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TRUMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-4033
Mailing Address - Country:US
Mailing Address - Phone:352-601-2019
Mailing Address - Fax:
Practice Address - Street 1:18550 US HIGHWAY 441 STE A
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6751
Practice Address - Country:US
Practice Address - Phone:352-735-3755
Practice Address - Fax:352-735-3151
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9384996163W00000X, 163WM0705X
FLAPRN11005182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical