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NPI Code Detail

MEDICARE: MARK MAXILOM DE CARVALHO APRN, FNP-C

MEDICARE:   MARK MAXILOM DE CARVALHO  APRN, FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner86375NM
2363LF0000XFamily Nurse Practitioner1099927TX
3363LF0000XFamily Nurse Practitioner5571183ID
4363LF0000XFamily Nurse Practitioner26NJ01261800NJ
5363LF0000XFamily Nurse PractitionerTPAN3116FL
6363LF0000XFamily Nurse Practitioner95025693CA
7363LF0000XFamily Nurse PractitionerSP024314PA
8363LF0000XFamily Nurse Practitioner349083NY
9363LF0000XFamily Nurse Practitioner277004816IL
10363LF0000XFamily Nurse Practitioner12488MN
11363LF0000XFamily Nurse Practitioner319429AZ
12363LF0000XFamily Nurse Practitioner14244166-4405UT
13363LF0000XFamily Nurse Practitioner860179NV
14363LF0000XFamily Nurse PractitionerAPN.1001430-NPCO
15363LF0000XFamily Nurse Practitioner101.0138405TELEVT

General Provider Information

NPI Number : 1306509971
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK MAXILOM DE CARVALHO APRN, FNP-C
Provider Business Mailing Address
First Line : 732 S 6TH ST # 8014
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-6948
Country : US
Telephone Number : 725-772-1939
Fax Number : 702-442-4665
Provider Business Practice Location Address
First Line : 732 S 6TH ST # 8014
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-6948
Country : US
Telephone Number : 725-772-1939
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2021
Last Update Date : 12/01/2025

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