Provider Demographics
NPI:1629660386
Name:PAUL, CARMENE
Entity Type:Individual
Prefix:
First Name:CARMENE
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16721 SAPPHIRE COURT
Mailing Address - Street 2:NONE
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331
Mailing Address - Country:US
Mailing Address - Phone:954-591-0857
Mailing Address - Fax:
Practice Address - Street 1:150 NW 20TH CT
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-5027
Practice Address - Country:US
Practice Address - Phone:954-591-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
FL237106376J00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No251E00000XAgenciesHome Health
No376J00000XNursing Service Related ProvidersHomemaker