Provider Demographics
NPI:1609186295
Name:CANTOR, CARLA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:
Last Name:CANTOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2160 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3585 NE 207TH ST STE C6
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3772
Practice Address - Country:US
Practice Address - Phone:833-376-6265
Practice Address - Fax:561-391-7797
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP 3384362363L00000X
FLAPRN3384362363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner