Individual
MR. CARL MARTIN KNISLEY-DESMOND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
HOME HEALTH NURSE
Contact information
Practice address
715 OAKDALE AVE APT 24, BROOKSVILLE, FL 34601-1913
(352) 444-0022
Mailing address
PO BOX 1483, BROOKSVILLE, FL 34605-1483
(352) 444-0222
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
1710569752
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710569752
HOME HEALTH PROVIDER
—
Enumeration date
06/30/2022
Last updated
09/09/2022
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