Provider Demographics
NPI:1003488123
Name:CARMONA, ESTELA MARIA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ESTELA
Middle Name:MARIA
Last Name:CARMONA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:ESTELA
Other - Middle Name:MARIA
Other - Last Name:CARMONA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:325 S BISCAYNE BLVD APT 823
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2307
Mailing Address - Country:US
Mailing Address - Phone:305-219-2304
Mailing Address - Fax:
Practice Address - Street 1:8281 SW 124TH ST
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-5957
Practice Address - Country:US
Practice Address - Phone:786-227-6506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013601363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE