Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 679056 | TX |
Y | 363LA2100X | Nurse Practitioner - Acute Care | F430868 | NY |
NPI | 1033490396 |
---|---|
Provider Name | Brisa Carmona |
First Address | New York, NY 10119-0002 |
Second Address | Bronx, NY 10471-1205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2011 |
Last Update Date | 11/08/2015 |