Provider Demographics
NPI:1619634672
Name:TOMAS CARRALERO, EGLIS (APRN)
Entity Type:Individual
Prefix:
First Name:EGLIS
Middle Name:
Last Name:TOMAS CARRALERO
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 1:9700 LEAWOOD BLVD APT 1505
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-2662
Mailing Address - Country:US
Mailing Address - Phone:407-731-7279
Mailing Address - Fax:
Practice Address - Street 1:3429 W 80TH ST APT 205
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-7571
Practice Address - Country:US
Practice Address - Phone:407-731-7279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11016702363L00000X
TX1138159163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse