CARSON LEE WAGNER (NPI# 1063060796) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063060796 |
| Entity Type | Individual |
| Full Name | CARSON LEE WAGNER |
| Practice Address |
1071 Calla Lily Cv Oviedo FL 32766-0003 |
| Practice Telephone | 4074091616 |
| Mailing Telephone | 4074091616 |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2019-10-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA9112577 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518446996 | Carson Jewel Wagner | Behavioral Analyst | 2995 Skyline Blvd Ste 201d, Reno, NV 89509-5163 | 2018-08-07 |
| Street Address |
1071 CALLA LILY CV |
| City | OVIEDO |
| State | FL |
| Zip Code | 32766-0003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427655588 | Tara Nicole La Salle | Pharmacist | 443 County Rd 419 Ste 1001, Oviedo, FL 32766 | 2020-10-01 |
| 1679052708 | Sharon Zachariah | Dentist | 1941 W County Road 419 Ste 1061, Chuluota, FL 32766 | 2018-08-09 |
| 1649791328 | Publix Super Markets, Inc | Durable Medical Equipment & Medical Supplies | 443 W. Cr 419, Ste 1001, Oveido, FL 32766 | 2017-07-03 |
| 1124249974 | Scott Peter Legrand | Social Worker | 2180 Snowhill Road, Chuluota, FL 32766 | 2007-05-01 |
| 1669980439 | Tammy M Bolles | Social Worker | 1708 Old River Trl., Chuluota, FL 32766-3276 | 2018-01-16 |
| 1437389756 | Lyret Carrasquillo | Behavioral Analyst | 151 Bluebrook Ct, Oviedo, FL 32766-5026 | 2009-07-21 |
| 1649766833 | Laurene Laureano | Physical Therapist | 2372 Pinebrook Ct, Oviedo, FL 32766-5048 | 2018-07-10 |
| 1720479314 | Gabriel Carrasquillo | Social Worker | 3073 Wolfe Ct, Oviedo, FL 32766-5068 | 2015-02-18 |
| 1194959403 | Shaping Speech, LLC | Speech-Language Pathologist | 1358 Twin Rivers Blvd, Oviedo, FL 32766-5082 | 2009-05-14 |
| 1548741762 | Vincent Farina | Physical Therapy Assistant | 669 Red Pepper Loop, Chuluota, FL 32766-6010 | 2018-08-25 |
| Find all providers in zip 32766 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013562610 | Kristy Ariel Gonzalez | Physician Assistant | 479 Portico Ct, Oviedo, FL 32765-5422 | 2019-08-09 |
| 1962985416 | Patrick Edward Tolan IIi | Physician Assistant | 2034 South St, Oviedo, FL 32765-6603 | 2018-09-11 |
| 1609392042 | Le Sage Surgical LLC | Physician Assistant | 2600 Dovehill Way, Oviedo, FL 32766-7070 | 2017-08-17 |
| 1750734604 | Kathryn Dianne Herden | Physician Assistant | 7560 Red Bug Lake Rd Ste 2048, Oviedo, FL 32765-6591 | 2016-07-15 |
| 1285004218 | Teresa Lynne Rogers | Physician Assistant | 1081 Sugarberry Trl, Oviedo, FL 32765-6039 | 2015-10-02 |
| 1306140017 | Jacob Eugene Phillips | Physician Assistant | 40 Alexandria Blvd, Ste. 1030, Oviedo, FL 32765-3300 | 2011-01-10 |
| 1023115813 | Kimmai Magali Lonsdorfer | Physician Assistant | 968 W Mitchell Hammock Rd Ste 1050, Oviedo, FL 32765-8123 | 2006-09-20 |
| 1134238124 | Vincent Polich | Physician Assistant | 1410 W Broadway St Ste 205, Oviedo, FL 32765-6472 | 2006-08-30 |
| 1629045307 | Diane C Hatch | Physician Assistant | 100 Alexandria Blvd, Oviedo, FL 32765-8298 | 2006-03-02 |
| 1902450661 | Dorothy Isidor | Physician Assistant | 2984 Alafaya Trl Ste 1030, Oviedo, FL 32765-7628 | 2019-07-30 |
| Find all providers in OVIEDO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.