Provider Demographics
NPI:1972993202
Name:PROUD, CARNLEY ELIZABETH (CLD, CBE, RYT200)
Entity type:Individual
Prefix:
First Name:CARNLEY
Middle Name:ELIZABETH
Last Name:PROUD
Suffix:
Gender:F
Credentials:CLD, CBE, RYT200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3689 BRITIAN CT
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-4700
Mailing Address - Country:US
Mailing Address - Phone:850-554-1159
Mailing Address - Fax:850-939-3886
Practice Address - Street 1:3689 BRITIAN CT
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-4700
Practice Address - Country:US
Practice Address - Phone:850-554-1159
Practice Address - Fax:850-939-3886
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula