# CARLSON MEDICAL, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wise Women
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518412238
- **Authorized official:** DR. INGRID A CARLSON MD (PRESIDENT)
- **Authorized official phone:** (904) 395-3577

## Contact information

- **Practice address:** 486 TOWN PLAZA AVE, SUITE 440, PONTE VEDRA, FL 32081-5141
- **Practice address phone:** (904) 395-3577
- **Practice address fax:** (904) 834-7821
- **Mailing address:** 486 TOWN PLAZA AVE, SUITE 440, PONTE VEDRA, FL 32081-5141
- **Mailing address phone:** (904) 395-3577
- **Mailing address fax:** (904) 834-7821

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | ME112115 | FL | Yes |

## Other

- **Enumeration date:** 08/23/2016
- **Last updated:** 08/23/2016