Provider Demographics
NPI:1174298012
Name:CARAVALHO, TONI (PA)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:CARAVALHO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:KAPAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96755-0432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45-539 PLUMERIA ST
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-6940
Practice Address - Country:US
Practice Address - Phone:808-775-7204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-1088363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant