Carly Jean Weaver

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APRN11001578 Issued in FL

Practice address

12470 Telecom Dr Ste 300W
Temple Terrace, FL 33637-0904

Phone

(813) 871-8200

Fax

(813) 357-5501

NPI assigned

Jun 7, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• University of Tennessee

  • Multi-Specialty Clinic/Center
  • Knoxville, TN
  • NPI 1295751386
  NPD (past)
• University of Tennessee

  • Pediatric Clinical Nurse Specialist
  • Knoxville, TN
  • NPI 1366756082
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1629637293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12470 TELECOM DR STE 300W",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336370904",
            "telephone_number": "813-871-8183",
            "fax_number": "813-871-8184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12470 TELECOM DR STE 300W",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336370904",
            "telephone_number": "813-871-8200",
            "fax_number": "813-357-5501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3003 W Dr Martin Luther King Jr Blvd",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336076307",
            "country_code": "US",
            "telephone_number": "813-871-8200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "CARLY",
        "middle_name": "JEAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-07",
        "last_updated": "2023-03-07",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "11001578",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11001578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF HEALTH",
            "identifier": "APRN11001578",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4ULEI",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David T Watson, MD
• Ricardo Watson III
• Tamica Watson, HAIR LOSS SPECIALIS
• Tony Michael Watson, PHARMD
• Greta Watts, MD
• Grant L Webb
• Lea Marie Weinstein, MA
• Marc A Weinstein, MD
• Samuel S Weinstein, M.D.
• Chelsea Wendyger

• Nurse Practitioner in Temple Terrace, FL
• Providers in Temple Terrace, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.