Provider Demographics
NPI:1518092071
Name:MCCRAVE, CARLA CECILIA (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:CECILIA
Last Name:MCCRAVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:CECILIA
Other - Last Name:MCCRAVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:813-689-7571
Mailing Address - Fax:813-654-8129
Practice Address - Street 1:11260 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-2140
Practice Address - Country:US
Practice Address - Phone:813-689-7571
Practice Address - Fax:813-654-8129
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1125232080P0207X, 208000000X
MO20090106522080P0207X
KS04337542080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007647900Medicaid