Healthcare Provider Details

I. General information

NPI: 1457458937
Provider Name (Legal Business Name): MS. CARLA CAMACHO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9908 GULF DRIVE
ANNA MARIA FL
34216
US

IV. Provider business mailing address

5512 19TH ST W
BRADENTON FL
34207
US

V. Phone/Fax

Practice location:
  • Phone: 941-778-2641
  • Fax: 941-779-2291
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRT2120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: