Healthcare Provider Details

I. General information

NPI: 1629896006
Provider Name (Legal Business Name): CARLY JEAN COMITO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE STE 121NE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-8595
  • Fax:
Mailing address:
  • Phone: 305-663-8595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11035619
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11035619
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: