Healthcare Provider Details

I. General information

NPI: 1336328418
Provider Name (Legal Business Name): CLARITA ESTHER CARRILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 10TH AVE N SUITE 202
LAKE WORTH FL
33461-3369
US

IV. Provider business mailing address

1926 10TH AVE N SUITE 202
LAKE WORTH FL
33461-3369
US

V. Phone/Fax

Practice location:
  • Phone: 561-588-4844
  • Fax: 561-588-3655
Mailing address:
  • Phone: 561-588-4844
  • Fax: 561-588-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP3285582
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberARNP3285582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: