Provider Demographics
NPI:1437727948
Name:MOREJON CARBONELL, DANILO
Entity Type:Individual
Prefix:
First Name:DANILO
Middle Name:
Last Name:MOREJON CARBONELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 NW 120TH LN
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2682
Mailing Address - Country:US
Mailing Address - Phone:954-678-8249
Mailing Address - Fax:
Practice Address - Street 1:7800 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2128
Practice Address - Country:US
Practice Address - Phone:954-670-1170
Practice Address - Fax:954-670-1171
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-12
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013634363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner