Healthcare Provider Details

I. General information

NPI: 1861140857
Provider Name (Legal Business Name): CARLA ANTONETTE YEARWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11306 MAYBROOK AVE
RIVERVIEW FL
33569-5900
US

IV. Provider business mailing address

11306 MAYBROOK AVE
RIVERVIEW FL
33569-5900
US

V. Phone/Fax

Practice location:
  • Phone: 443-418-0541
  • Fax:
Mailing address:
  • Phone: 443-418-0541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: