Individual
MR. KEVIN K CARLISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
12880 COMMODITY PL, TAMPA, FL 33626-3101
(813) 343-5500
(866) 462-7445
Mailing address
PO BOX 21686, TAMPA, FL 33622-1686
(813) 343-5500
(866) 462-7445
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA1682
FL
363AS0400X
Surgical Physician Assistant
Primary
PA1682
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290188900
—
FL
01
—
650420578
CHAMPUS/TRICARE
FL
01
—
X1592
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/14/2005
Last updated
03/04/2026
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