Healthcare Provider Details

I. General information

NPI: 1477448033
Provider Name (Legal Business Name): CARLA ROSA DE JESUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 FLATLANDS AVE
BROOKLYN NY
11234-3507
US

IV. Provider business mailing address

2918 TENBROECK AVE
BRONX NY
10469-5229
US

V. Phone/Fax

Practice location:
  • Phone: 718-444-7766
  • Fax: 718-444-3709
Mailing address:
  • Phone: 917-609-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number356687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: