Healthcare Provider Details

I. General information

NPI: 1669335543
Provider Name (Legal Business Name): PAULINA CARRACEDO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 PALERMO AVE
CORAL GABLES FL
33134-6607
US

IV. Provider business mailing address

6830 SW 45TH LN APT 8
MIAMI FL
33155-6823
US

V. Phone/Fax

Practice location:
  • Phone: 305-308-8860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11043926
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: