Provider Demographics
NPI:1043631682
Name:CARVAJAL, RAISA MARIA (RN, MSN, IBCLC, CLC)
Entity Type:Individual
Prefix:MRS
First Name:RAISA
Middle Name:MARIA
Last Name:CARVAJAL
Suffix:
Gender:F
Credentials:RN, MSN, IBCLC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10016 BROMPTON DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10016 BROMPTON DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-5163
Practice Address - Country:US
Practice Address - Phone:786-277-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-29
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9266145163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
L45601OtherINTERNATIONAL CERTIFIED LACTATION CONSULTANT
FLRN9266145OtherRN