Provider Demographics
NPI:1174591168
Name:JARAMILLO-FORD, CARLA A (CRNA MS)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:A
Last Name:JARAMILLO-FORD
Suffix:
Gender:F
Credentials:CRNA MS
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:A
Other - Last Name:GOULD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA MS
Mailing Address - Street 1:65 STANWELL ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7918
Mailing Address - Country:US
Mailing Address - Phone:850-774-2082
Mailing Address - Fax:
Practice Address - Street 1:65 STANWELL ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-7918
Practice Address - Country:US
Practice Address - Phone:850-774-2082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3149572367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305541800Medicaid
FL305541800Medicaid