Provider Demographics
NPI:1619532470
Name:CARMONA, JAMIE (ARNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:CARMONA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 BONGART RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2611
Mailing Address - Country:US
Mailing Address - Phone:407-965-6292
Mailing Address - Fax:
Practice Address - Street 1:2685 BONGART RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2611
Practice Address - Country:US
Practice Address - Phone:407-965-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF05190139363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily