Provider Demographics
NPI:1962243352
Name:NASH, CAROLYN (BS, ITDS)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:NASH
Suffix:
Gender:F
Credentials:BS, ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 S SCARLET OAK CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6141
Mailing Address - Country:US
Mailing Address - Phone:303-859-7064
Mailing Address - Fax:
Practice Address - Street 1:2490 S SCARLET OAK CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6141
Practice Address - Country:US
Practice Address - Phone:303-859-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-01
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist