Provider Demographics
NPI:1053624221
Name:CARSON, ELIZABETH D (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:CARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CARSON
Other - Last Name:WEINSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4111 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1743
Mailing Address - Country:US
Mailing Address - Phone:727-947-9995
Mailing Address - Fax:727-938-8693
Practice Address - Street 1:4111 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1743
Practice Address - Country:US
Practice Address - Phone:727-938-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1043236565OtherGROUP NPI
FL1053624221OtherNPI
FLEP993YMedicare PIN
FL1043236565OtherGROUP NPI