Active NPI
Carolyn Ann Space, CNP
- Nurse Practitioner
- Eglin, FL
National Provider Identifier
1336553585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- ARNP9457268
- Practice address
- 96 MDG
307 Boatner Road
Eglin, FL 32542 - Phone
- (850) 883-9957
- NPI assigned
- Jun 16, 2014
- Last updated
- Sep 24, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | ARNP9457268 | FL | Primary |
Addresses
Primary practice location
96 MDG
307 Boatner Road
Eglin, FL 32542
Mailing address
96MDG
307 Boatner Road Attn: Credentials
Eglin, FL 32542
Phone (850) 883-9957
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221205000045 | FL | Order and Referring Only - Nurse Practitioner | 2860619665 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537747200000",
"number": "1336553585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "96MDG",
"address_2": "307 BOATNER ROAD ATTN: CREDENTIALS",
"city": "EGLIN",
"state": "FL",
"postal_code": "32542",
"telephone_number": "850-883-9957"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "96 MDG",
"address_2": "307 BOATNER ROAD",
"city": "EGLIN",
"state": "FL",
"postal_code": "32542",
"telephone_number": "850-883-9957"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPACE",
"first_name": "CAROLYN",
"middle_name": "ANN",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-16",
"last_updated": "2018-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "FL",
"license": "ARNP9457268",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eglin, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.