Provider Demographics
NPI:1912161258
Name:BIRD, CAROLYN ALEXIS (MPAS)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ALEXIS
Last Name:BIRD
Suffix:
Gender:F
Credentials:MPAS
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ALEXIS
Other - Last Name:KENSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6100 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3271
Mailing Address - Country:US
Mailing Address - Phone:727-544-5437
Mailing Address - Fax:727-541-7961
Practice Address - Street 1:6100 PARK BLVD
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3271
Practice Address - Country:US
Practice Address - Phone:727-544-5437
Practice Address - Fax:727-541-7961
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT 9104616363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical