Individual
INGRID CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
395 3RD ST, ATLANTIC BEACH, FL 32233-5231
(904) 466-2841
Mailing address
395 3RD ST, ATLANTIC BEACH, FL 32233-5231
(904) 466-2841
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
016275
ME
207V00000X
Obstetrics & Gynecology Physician
47025
KY
207VG0400X
Gynecology Physician
2019016072
MO
207VG0400X
Gynecology Physician
62087
GA
207VG0400X
Gynecology Physician
Primary
ME112115
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME014001
MEDICARE TYPE UNSPECIFIED
ME
Enumeration date
01/18/2006
Last updated
08/15/2019
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