Provider Demographics
NPI:1932419140
Name:CARLIN, LISA JEANNETTE (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JEANNETTE
Last Name:CARLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-838-8494
Practice Address - Street 1:2325 W ARBORS DR STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2664
Practice Address - Country:US
Practice Address - Phone:704-295-3500
Practice Address - Fax:704-295-3468
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02552363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1932419140Medicaid
NC1932419140Medicaid
NCNC1422AMedicare PIN
NC1932419140Medicaid
NCNC1422GMedicare PIN
NCNC1422FMedicare PIN
NCNC1422CMedicare PIN
NCNC1422BMedicare PIN
NCNC1422EMedicare PIN