Healthcare Provider Details

I. General information

NPI: 1386486355
Provider Name (Legal Business Name): CAROLINA RENDON-GARCIA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RISING RD
NORWALK CT
06850-4310
US

IV. Provider business mailing address

761 MAIN AVE BLDG D, SUITE 203
NORWALK CT
06851-1080
US

V. Phone/Fax

Practice location:
  • Phone: 203-428-7362
  • Fax:
Mailing address:
  • Phone: 203-852-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13245
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: