Provider Demographics
NPI:1700392172
Name:FREIRE, MARIA DEL CARMEN (PA)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DEL CARMEN
Last Name:FREIRE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:DEL CARMEN
Other - Last Name:MANDRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10325 BIRCH TREE LN
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-8021
Mailing Address - Country:US
Mailing Address - Phone:407-951-1677
Mailing Address - Fax:
Practice Address - Street 1:1510 CITRUS MEDICAL CT
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4547
Practice Address - Country:US
Practice Address - Phone:407-480-4830
Practice Address - Fax:407-480-4834
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant