Healthcare Provider Details

I. General information

NPI: 1720899396
Provider Name (Legal Business Name): CAROLINA HERNANDEZ ESPINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SE PORT ST LUCIE BLVD STE 3
PORT ST LUCIE FL
34984-5108
US

IV. Provider business mailing address

260 ALEMEDA DR APT 12
PALM SPRINGS FL
33461-1619
US

V. Phone/Fax

Practice location:
  • Phone: 772-202-0173
  • Fax: 772-209-7631
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-400269
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: