Healthcare Provider Details

I. General information

NPI: 1558119891
Provider Name (Legal Business Name): CAROLINA GONZALEZ FOREMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NW 7TH AVE
FORT LAUDERDALE FL
33311-9026
US

IV. Provider business mailing address

1608 SE 3RD AVE FL 3
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-759-6600
  • Fax: 954-759-6665
Mailing address:
  • Phone: 954-759-6600
  • Fax: 954-759-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number363LW0102X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: