Provider Demographics
NPI:1073195202
Name:FOUBELO, CARMEN (NP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:FOUBELO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 CELEBRATION BLVD STE 238
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5159
Mailing Address - Country:US
Mailing Address - Phone:855-228-0790
Mailing Address - Fax:
Practice Address - Street 1:1420 CELEBRATION BLVD STE 238
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5159
Practice Address - Country:US
Practice Address - Phone:855-228-0790
Practice Address - Fax:866-422-3202
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily