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General NPI Number Information
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NPI Number | 1104658608
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Entity Type | Individual
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Provider Name | BETSY S CARRASQUILLO
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Gender | Female
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Dates
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Enumeration Date | 08/14/2024
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 5381 PRIMROSE LAKE CIR
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City | TAMPA
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State | FL
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Zip | 33647-3521
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Country | US
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Telephone | 813-615-2488
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Fax |
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Provider Business Mailing Address
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Address Line | 111 LAKE HOLLINGSWORTH DR
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City | LAKELAND
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State | FL
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Zip | 33801-5607
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Country | US
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Telephone | 863-680-4111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11034568
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License Number State | FL
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