Provider Demographics
NPI:1962960716
Name:EVERHART, CARLISA D
Entity type:Individual
Prefix:MRS
First Name:CARLISA
Middle Name:D
Last Name:EVERHART
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 1:3224 OAKLEY AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-1840
Mailing Address - Country:US
Mailing Address - Phone:727-430-2499
Mailing Address - Fax:
Practice Address - Street 1:3224 OAKLEY AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-1840
Practice Address - Country:US
Practice Address - Phone:727-430-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234432372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion