MEDICARE: CARLA K GARCIA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	0990749	CO
2	363LF0000X	Family Nurse Practitioner	APN.0990749-NP	CO
3	363LG0600X	Gerontology Nurse Practitioner	APN0990749-NP	CO
4	364SA2100X	Acute Care Clinical Nurse Specialist	11018443	FL
5	163W00000X	Registered Nurse	RN.0170353	CO
6	363L00000X	Nurse Practitioner	APN.0990749-NP	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023457751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA K GARCIA FNP

Provider Business Mailing Address
First Line	:	21298 OLEAN BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6765
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21298 OLEAN BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6765
Country	:	US
Telephone Number	:	941-629-1181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2013
Last Update Date	:	07/11/2022

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