Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN11013601 | FL |
NPI | 1003488123 |
---|---|
Provider Name | Mrs. Estela Maria Carmona |
First Address | Miami, FL 33131-2307 |
Second Address | Pinecrest, FL 33156-5957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2021 |
Last Update Date | 16/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NONE | NONE (01) |