Healthcare Provider Details

I. General information

NPI: 1205583093
Provider Name (Legal Business Name): CARLOS EDUARDO RAMOS MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 TAMIAMI TRL STE A
PORT CHARLOTTE FL
33952-3922
US

IV. Provider business mailing address

7908 SPRING VALLEY DR
TAMPA FL
33615-2117
US

V. Phone/Fax

Practice location:
  • Phone: 855-674-7400
  • Fax:
Mailing address:
  • Phone: 813-802-0468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN1101840
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: