Healthcare Provider Details

I. General information

NPI: 1760347413
Provider Name (Legal Business Name): CARLO EDOUARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16853 NE 2ND AVE STE 304
NORTH MIAMI BEACH FL
33162-1776
US

IV. Provider business mailing address

5959 NW 24TH CT
SUNRISE FL
33313-2932
US

V. Phone/Fax

Practice location:
  • Phone: 786-414-6666
  • Fax: 786-221-3542
Mailing address:
  • Phone: 954-709-9040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11044103
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: