Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 9219683 | FL |
NPI | 1003237637 |
---|---|
Provider Name | Anita Carrillo |
First Address | Key Biscayne, FL 33149-2506 |
Second Address | Key Biscayne, FL 33149-2506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2013 |
Last Update Date | 07/07/2015 |