Provider Demographics
NPI:1174549703
Name:CARBO, CLARISSA IRMINA (ARNP)
Entity type:Individual
Prefix:MS
First Name:CLARISSA
Middle Name:IRMINA
Last Name:CARBO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11760 SW 40TH ST
Mailing Address - Street 2:SUITE 654
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3582
Mailing Address - Country:US
Mailing Address - Phone:786-615-6123
Mailing Address - Fax:786-615-6103
Practice Address - Street 1:11760 SW 40 STREET
Practice Address - Street 2:SUITE 654
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8103
Practice Address - Country:US
Practice Address - Phone:786-615-6123
Practice Address - Fax:786-615-6103
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP1227232363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033814100Medicaid
FL033814100Medicaid