Basic Information
Provider Information
NPI: 1770551202
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAZZONE
FirstName: CAROLE
MiddleName: STONE
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4200 N ARMENIA AVE
Address2: SUITE 1
City: TAMPA
State: FL
PostalCode: 336076438
CountryCode: US
TelephoneNumber: 8138774811
FaxNumber: 8138728978
Practice Location
Address1: 4200 N ARMENIA AVE
Address2: SUITE 1
City: TAMPA
State: FL
PostalCode: 336076438
CountryCode: US
TelephoneNumber: 8138774811
FaxNumber: 8138728978
Other Information
ProviderEnumerationDate: 03/10/2006
LastUpdateDate: 05/10/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200XARNP3164882FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


Home