=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760116685
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE CARRERO MSN, AGNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2022
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5504 PINEBROOK RD STE 206
-----------------------------------------------------
City | NORTH VENICE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34275-3745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-917-8900
-----------------------------------------------------
Fax | 941-917-8955
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 947407
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30394-7407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-917-2600
-----------------------------------------------------
Fax | 941-917-7884
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 11020709
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN11020709
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------