Healthcare Provider Details

I. General information

NPI: 1194129106
Provider Name (Legal Business Name): VIVIAN CARO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-3040
  • Fax: 321-841-3049
Mailing address:
  • Phone: 321-841-3040
  • Fax: 321-841-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9108292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: