Provider Demographics
NPI:1679262489
Name:WILBORN, CARRIE
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:WILBORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 DAVIS PKWY APT 9
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33034-3184
Mailing Address - Country:US
Mailing Address - Phone:863-940-1348
Mailing Address - Fax:
Practice Address - Street 1:942 DAVIS PKWY APT 9
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33034-3184
Practice Address - Country:US
Practice Address - Phone:863-940-1348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities