Healthcare Provider Details

I. General information

NPI: 1982101440
Provider Name (Legal Business Name): KARISA FALDEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 01/30/2022
Certification Date: 01/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 OVERSEAS HWY STE 17
MARATHON FL
33050-2784
US

IV. Provider business mailing address

PO BOX 100707
ATLANTA GA
30384-0707
US

V. Phone/Fax

Practice location:
  • Phone: 305-434-1000
  • Fax: 305-743-0962
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS17881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: