Provider Demographics
NPI:1043891773
Name:CARRASCO PARDO, JANETH (MS-FNP)
Entity Type:Individual
Prefix:
First Name:JANETH
Middle Name:
Last Name:CARRASCO PARDO
Suffix:
Gender:F
Credentials:MS-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 NW 114TH AVE APT 1135
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4575
Mailing Address - Country:US
Mailing Address - Phone:786-768-1319
Mailing Address - Fax:
Practice Address - Street 1:6400 NW 114TH AVE APT 1135
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4575
Practice Address - Country:US
Practice Address - Phone:786-768-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012615363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily