MEDICARE: CARLA C CHEN APRN

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	363LF0000X	Family Nurse Practitioner	9335292	FL

General Provider Information

NPI Number	:	1457847832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA C CHEN APRN

Provider Business Mailing Address
First Line	:	9112 LAKE LOTTA CIR
Second Line	:
City	:	GOTHA
State	:	FL
Zip	:	34734-5042
Country	:	US
Telephone Number	:	407-697-7429
Fax Number	:

Provider Business Practice Location Address
First Line	:	9112 LAKE LOTTA CIR
Second Line	:
City	:	GOTHA
State	:	FL
Zip	:	34734-5042
Country	:	US
Telephone Number	:	407-697-7429
Fax Number	:

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

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	02/14/2019

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