| Doctor Name: | CAROLYN ANN SPACE |
| NPI Number: | 1336553585 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | COA. 15929-NP |
| Business Practice Address: | 37304 Kings Hwy Beaver Island, MI - 497825134 |
| Business Phone Number: | 2314482275 |
| Business Fax Number: | 2314482348 |
| Mailing Address: | Po Box 146, BEAVER ISLAND |
| State: | MI |
| Postal Code: | 497820146 |
| Phone Number: | 2314482275 |
| Fax Number: | 2314482348 |
| NPI Enumeration Date: | 06/16/2014 |
| NPI Last Update Date: | 01/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | COA. 15929-NP |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |