Provider Demographics
NPI:1114530078
Name:CARMENATE, EDILIA (AG-APRN)
Entity Type:Individual
Prefix:
First Name:EDILIA
Middle Name:
Last Name:CARMENATE
Suffix:
Gender:F
Credentials:AG-APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:2900 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-1645
Practice Address - Country:US
Practice Address - Phone:954-748-8200
Practice Address - Fax:855-852-1969
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL645754363LP2300X
FLAPRN11009028363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care