Healthcare Provider Details

I. General information

NPI: 1134821242
Provider Name (Legal Business Name): LAURA HERNANDEZ CARRATALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15455 COLLIER BLVD UNIT 201
NAPLES FL
34119-7874
US

IV. Provider business mailing address

15455 COLLIER BLVD UNIT 201
NAPLES FL
34119-7874
US

V. Phone/Fax

Practice location:
  • Phone: 239-514-2005
  • Fax: 239-593-0067
Mailing address:
  • Phone: 239-514-2005
  • Fax: 239-593-0067

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 Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME175863
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: