Provider Demographics
NPI:1073113973
Name:FELICO PUPO, CARLOS JOSUE SR (APRN)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JOSUE
Last Name:FELICO PUPO
Suffix:SR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10405 OLD CUTLER RD APT 202
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1708
Mailing Address - Country:US
Mailing Address - Phone:786-650-5190
Mailing Address - Fax:
Practice Address - Street 1:10980 SW 184TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6615
Practice Address - Country:US
Practice Address - Phone:305-571-6292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009813163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty