Provider Demographics
NPI:1003274473
Name:FIORAMANTI, CARLY DELBERT (APRN)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:DELBERT
Last Name:FIORAMANTI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:BETH
Other - Last Name:DELBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:276 S HUNTLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-6978
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-2603
Practice Address - Country:US
Practice Address - Phone:863-659-1079
Practice Address - Fax:863-659-1317
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9302815363LA2200X
FLARNP9302815363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016664500Medicaid
FLDQEADOtherBLUE CROSS BLUE SHIELD
FLDQEADOtherBLUE CROSS BLUE SHIELD