Provider Demographics
NPI:1508587122
Name:CARRION, AGOSTINA
Entity Type:Individual
Prefix:
First Name:AGOSTINA
Middle Name:
Last Name:CARRION
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 1:3300 NE 191ST ST APT 809
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2443
Mailing Address - Country:US
Mailing Address - Phone:786-273-6383
Mailing Address - Fax:
Practice Address - Street 1:1115 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1256
Practice Address - Country:US
Practice Address - Phone:954-674-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant