Provider Demographics
NPI:1679460190
Name:CARINO, IAN MARIE DE PERALTA (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:IAN MARIE
Middle Name:DE PERALTA
Last Name:CARINO
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:MISS
Other - First Name:IAN MARIE
Other - Middle Name:PARRA
Other - Last Name:DE PERALTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 270432
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-0432
Mailing Address - Country:US
Mailing Address - Phone:361-765-4713
Mailing Address - Fax:
Practice Address - Street 1:6330 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3481
Practice Address - Country:US
Practice Address - Phone:361-415-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1203517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily