Provider Demographics
NPI:1235465162
Name:CARNEMOLLA, MIRIAM C (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:C
Last Name:CARNEMOLLA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:MIRIAM
Other - Middle Name:C
Other - Last Name:CARNEMOLLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:2415 N. ORANGE AVE SUITE 502
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-303-2801
Mailing Address - Fax:407-303-2865
Practice Address - Street 1:7727 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8224
Practice Address - Country:US
Practice Address - Phone:407-303-6749
Practice Address - Fax:407-303-6864
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9192748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily