Healthcare Provider Details

I. General information

NPI: 1306613237
Provider Name (Legal Business Name): CARLA DE SOUZA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13127 VAIL RIDGE DR
RIVERVIEW FL
33579-7196
US

IV. Provider business mailing address

6910 JAMESTOWN MANOR DR
RIVERVIEW FL
33578-8303
US

V. Phone/Fax

Practice location:
  • Phone: 813-661-6199
  • Fax:
Mailing address:
  • Phone: 813-598-1081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11029849
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11029849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: