Healthcare Provider Details

I. General information

NPI: 1689777955
Provider Name (Legal Business Name): CARLOS ENRIQUE CARRANZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S FLORIDA ST
BUSHNELL FL
33513-6703
US

IV. Provider business mailing address

212 S FLA ST
BUSHNELL FL
33513-6703
US

V. Phone/Fax

Practice location:
  • Phone: 352-787-1600
  • Fax: 352-793-3282
Mailing address:
  • Phone: 352-793-2441
  • Fax: 888-599-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: