Healthcare Provider Details

I. General information

NPI: 1164132999
Provider Name (Legal Business Name): VALERIE F. CARBALLOSA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 GOODLETTE RD. NORTH SUITE 200, 2ND FLOOR
NAPLES FL
34102-5644
US

IV. Provider business mailing address

PO BOX 749495
ATLANTA GA
30374-9495
US

V. Phone/Fax

Practice location:
  • Phone: 239-231-7260
  • Fax: 239-567-3667
Mailing address:
  • Phone: 855-963-2100
  • Fax: 813-321-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9463173
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11023441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: