Provider Demographics
NPI:1609468479
Name:CUMMINGS, CARRIE LYN (DNP)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:LYN
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13848 HERONS LANDING WAY APT 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-6064
Mailing Address - Country:US
Mailing Address - Phone:904-463-6698
Mailing Address - Fax:
Practice Address - Street 1:209 PONTE VEDRA PARK DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-6600
Practice Address - Country:US
Practice Address - Phone:904-273-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011263363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner