MEDICARE: REBECA CARBALLO VALDES

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	363LP0200X	Pediatric Nurse Practitioner	APRN11043844	FL
2	363LF0000X	Family Nurse Practitioner	APRN11043844	FL

General Provider Information

NPI Number	:	1861355133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECA CARBALLO VALDES

Provider Business Mailing Address
First Line	:	2916 42ND ST W
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33971-5790
Country	:	US
Telephone Number	:	305-586-6736
Fax Number	:

Provider Business Practice Location Address
First Line	:	2916 42ND ST W
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33971-5790
Country	:	US
Telephone Number	:	305-586-6736
Fax Number	:

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

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	05/25/2026

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Directions to “ REBECA CARBALLO VALDES ” Practice Location

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