Healthcare Provider Details

I. General information

NPI: 1518092071
Provider Name (Legal Business Name): CARLA CECILIA MCCRAVE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLA CECILIA MCCRAVE MD

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11260 SULLIVAN ST
RIVERVIEW FL
33578-2140
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 813-689-7571
  • Fax: 813-654-8129
Mailing address:
  • Phone: 813-689-7571
  • Fax: 813-654-8129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME112523
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME112523
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number2009010652
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number0433754
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: