Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 43760 | TN |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 43760 | TN |
NPI | 1356521991 |
---|---|
Provider Name | Dr. Dafnis Carolina Carranza |
First Address | Humboldt, TN 38343-3034 |
Second Address | Humboldt, TN 38343-3034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2007 |
Last Update Date | 05/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3001556 | (05) | TN |
P00634097 | RR MEDICARE (01) | TN |