Provider Demographics
NPI:1114226362
Name:CARRILLO, CHRISTINE RENE (RN, RNFA, CNOR)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RENE
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:RN, RNFA, CNOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3312
Mailing Address - Country:US
Mailing Address - Phone:321-268-0720
Mailing Address - Fax:321-383-7596
Practice Address - Street 1:1311 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3312
Practice Address - Country:US
Practice Address - Phone:321-268-0720
Practice Address - Fax:321-383-7596
Is Sole Proprietor?:No
Enumeration Date:2011-03-26
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2055572163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN2055572OtherFLORIDA NURSING LICENSE