Provider Demographics
NPI:1336328418
Name:CARRILLO, CLARITA ESTHER
Entity Type:Individual
Prefix:
First Name:CLARITA
Middle Name:ESTHER
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 10TH AVE N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3369
Mailing Address - Country:US
Mailing Address - Phone:561-588-4844
Mailing Address - Fax:561-588-3655
Practice Address - Street 1:1926 10TH AVE N
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3369
Practice Address - Country:US
Practice Address - Phone:561-588-4844
Practice Address - Fax:561-588-3655
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3285582174400000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health