| Doctor Name: | MISS CAROLINE ALICIA WALBURG |
| NPI Number: | 1073936928 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A. |
| License Number: | PA9107781 |
| Business Practice Address: | 625 6th Avenue South Suite 450 St. Petersburg, FL - 337014629 |
| Business Phone Number: | 7278982663 |
| Business Fax Number: | 7275686836 |
| Mailing Address: | 625 6th Avenue South, Suite 450 ST. PETERSBURG |
| State: | FL |
| Postal Code: | 337014629 |
| Phone Number: | 7278982663 |
| Fax Number: | 7275686836 |
| NPI Enumeration Date: | 01/29/2014 |
| NPI Last Update Date: | 03/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA9107781 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |