Provider Demographics
NPI:1417433624
Name:ECHIZARRAGA, CARMEN JULIA (APRN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:JULIA
Last Name:ECHIZARRAGA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 SW 129TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2719
Mailing Address - Country:US
Mailing Address - Phone:786-768-5801
Mailing Address - Fax:
Practice Address - Street 1:3401 SW 129TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2719
Practice Address - Country:US
Practice Address - Phone:786-768-5801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF06182345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily