Provider Demographics
NPI:1104855915
Name:CARBON, ADRIANA E (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:E
Last Name:CARBON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 CYPRESS VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6801
Mailing Address - Country:US
Mailing Address - Phone:813-633-3600
Mailing Address - Fax:813-634-8210
Practice Address - Street 1:781 CYPRESS VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6801
Practice Address - Country:US
Practice Address - Phone:813-633-3600
Practice Address - Fax:813-634-8210
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1720747OtherCIGNA PROVIDER NUMBER
FL293121OtherWELLCARE PROVIDER NUMBER
FL30999OtherBCBS PROVIDER NUMBER
FL593400761OtherHUMANA MEDICARE PROVIDER NUMBER
FL593400761COtherHUMANA COMMERCIAL PROVIDER NUMBER
FL21699Medicare PIN
FL30999OtherBCBS PROVIDER NUMBER
FL30999OtherBCBS PROVIDER NUMBER