Healthcare Provider Details

I. General information

NPI: 1386091676
Provider Name (Legal Business Name): CARLO ROBERTO OROZCO FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S 11TH ST STE 1
COEUR D ALENE ID
83814-4000
US

IV. Provider business mailing address

212 S 11TH ST STE 1
COEUR D'ALENE ID
83814-4000
US

V. Phone/Fax

Practice location:
  • Phone: 208-243-9395
  • Fax: 208-668-8213
Mailing address:
  • Phone: 208-243-9395
  • Fax: 951-466-2426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP65298
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number65298
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61360767
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number65298
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61360767
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number65298
License Number StateID
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95004065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: