Healthcare Provider Details

I. General information

NPI: 1073113973
Provider Name (Legal Business Name): CARLOS FELICO PUPO SR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LOOPDALE LN
KISSIMMEE FL
34741-7658
US

IV. Provider business mailing address

2900 LOOPDALE LN
KISSIMMEE FL
34741-7658
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-0232
  • Fax: 407-675-3558
Mailing address:
  • Phone: 407-900-0232
  • Fax: 407-675-3558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number11009813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: