Provider Demographics
NPI:1558963462
Name:CARMENATE, GINA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:CARMENATE
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 1:6825 SW 45TH LN APT 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6821
Mailing Address - Country:US
Mailing Address - Phone:786-226-4404
Mailing Address - Fax:
Practice Address - Street 1:6825 SW 45TH LN APT 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6821
Practice Address - Country:US
Practice Address - Phone:786-226-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily