Healthcare Provider Details

I. General information

NPI: 1558982447
Provider Name (Legal Business Name): HAENDEL CARRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 ROUTE DE DELMAS
DELMAS PORT AU PRINCE
HT6120
HT

IV. Provider business mailing address

12209 76TH RD N
WEST PALM BEACH FL
33412-2277
US

V. Phone/Fax

Practice location:
  • Phone: 561-412-8027
  • Fax: 561-412-8027
Mailing address:
  • Phone: 561-412-8027
  • Fax: 561-412-8027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9323474
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number816
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: