Healthcare Provider Details

I. General information

NPI: 1639351380
Provider Name (Legal Business Name): CARMEN M ECHEVARRIA MELETICHE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13940 N US HIGHWAY 441 STE 102
LADY LAKE FL
32159-8909
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 352-751-9900
  • Fax:
Mailing address:
  • Phone: 800-480-5243
  • Fax: 800-928-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16925
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN638
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: