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Individual

CAROLYN ANN SPACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
96 MDG, 307 BOATNER ROAD, EGLIN, FL 32542
(850) 883-9957
Mailing address
96MDG, 307 BOATNER ROAD ATTN: CREDENTIALS, EGLIN, FL 32542
(850) 883-9957

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP9457268
FL

Other

Enumeration date
06/16/2014
Last updated
09/24/2018
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