Healthcare Provider Details

I. General information

NPI: 1013774538
Provider Name (Legal Business Name): CARLA PETION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21073 POWERLINE RD STE 35
BOCA RATON FL
33433-2306
US

IV. Provider business mailing address

6101 W ATLANTIC BLVD STE 101
MARGATE FL
33063-5157
US

V. Phone/Fax

Practice location:
  • Phone: 728-500-4454
  • Fax:
Mailing address:
  • Phone: 786-587-0915
  • Fax: 786-761-9231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11023417
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11023417
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: