Individual
CARLY JEAN WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12470 TELECOM DR STE 300W, TEMPLE TERRACE, FL 33637-0904
(813) 871-8200
(813) 357-5501
Mailing address
12470 TELECOM DR STE 300W, TEMPLE TERRACE, FL 33637-0904
(813) 871-8183
(813) 871-8184
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN11001578
FL
363LP0200X
Pediatric Nurse Practitioner
11001578
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4ULEI
BLUE CROSS BLUE SHIELD
FL
01
—
APRN11001578
DEPARTMENT OF HEALTH
FL
Enumeration date
06/07/2019
Last updated
03/07/2023
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