Healthcare Provider Details

I. General information

NPI: 1376411074
Provider Name (Legal Business Name): VIVIAN CARIDAD CARBONELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2025
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E 33RD ST
HIALEAH FL
33013-3355
US

IV. Provider business mailing address

702 E 33RD ST
HIALEAH FL
33013-3355
US

V. Phone/Fax

Practice location:
  • Phone: 786-317-3397
  • Fax:
Mailing address:
  • Phone: 786-317-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number9643910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: